Abstract
1.Cervantes et al report on a study of a vulnerable population, undocumented immigrants with end-stage renal disease.A.Describe some of the factors that contribute to disparities in outcomes among undocumented patients.B.How might some of the above factors differ among the San Francisco, Houston, and Denver study sites?2.A.What is the insurance composition of long-term dialysis-dependent patient population in the United States?B.How does this lack of insurance affect the ability of the undocumented to receive treatment for end-stage renal disease? What parts of the healthcare system are they dependent on for their care?3.What are some of the detrimental effects (eg, medical, social, psychological) for patients who rely on emergency dialysis versus standard dialysis and how might that contribute to increased mortality?4.A.What is a propensity score analysis and why might an investigator use this technique?B.Briefly describe the 4 types of propensity score analysis. Which method was used in this analysis?C.In their analysis, Cervantes et al report a process of giving precedence for “colinear variables statistically (P<0.05) or clinically associated with the exposure and outcome.” What is collinearity? What is the rationale and implications of this analytic choice?D.What are some of the limitations of propensity score analysis, especially compared with a randomized controlled trial?5.Cervantes et al used a propensity score analysis to compare undocumented patients receiving emergency versus standard dialysis because of state-level variations in provisions for undocumented patients.A.Which variables composed the propensity score used to match patients in this analysis?B.Knowing these vulnerable populations can be difficult to study and can have population-specific determinants that affect their health outcomes, is there additional information that would be optimal to include in the propensity score? What effect would it have on the study outcomes?6.Despite the limitations of this study, the article depicts an important mortality disparity in dialysis-dependent patients and how undocumented status can contribute to poor health.A.At the system level, how might emergency dialysis and standard dialysis compare in terms of cost?B.What logistic burden do the systems of emergency dialysis used in Colorado and Texas impose on emergency departments?C.What ethical dilemmas does this cause for emergency providers?D.What can emergency providers do about the situation?
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