Quality Incentive Program Research Articles

Clinician Knowledge and Attitudes About Climate Change and Health After a Quality Incentive Program

Climate change is a fundamental threat to human health, and industries, including health care, must assess their respective contribution to this crisis. To assess the change in knowledge of clinicians who completed a quality incentive program (QIP) measure on climate change and health care sustainability and to examine clinician attitudes toward climate change and their perception of clinical and individual relevance. The participants in this survey study included employed physicians and psychologists who were part of a hospital physician organization in an academic medical center (AMC) in Boston, Massachusetts. The hospital physician organization provides a QIP with different measures every 6 months and provides incentive payments on completion. The study is based on a survey of participants on completion of a QIP measure focused on climate change and health care sustainability offered from July 2023 through September 2023 at the AMC. Structured educational video modules. After completion of the modules, the participants reported their baseline and postintervention knowledge on climate change impacts on health and health care sustainability, perceived relevance of the material, and attitudes toward the modules using 5-point Likert scales and free-text comments. Data were analyzed using univariate and multivariable analyses including participant age, gender, and practice specialty. Of the 2559 eligible clinicians, 2417 (94.5%) (mean [SD] age, 48.9 [11.5] years; range, 29-85 years; 1244 males [51.5%]) participated in the measure and completed the survey. Among these participants, 1767 (73.1%) thought the modules were relevant or very relevant to their lives and 1580 (65.4%) found the modules relevant or very relevant to their clinical practice. Age was not associated with responses. Practitioners in specialties classified as climate facing were more likely to think that the education was relevant to their clinical practice compared with those in non-climate-facing specialties (mean [SD] score, 3.76 [1.19] vs 3.61 [1.26]; P = .005). Practitioners identifying as female were also more likely to consider this education as relevant to their clinical practice compared with male practitioners (mean [SD] score, 3.82 [1.17] vs 3.56 [1.27]; P < .001). In this survey study, a high proportion of clinicians expressed positive attitudes toward education in climate change and health and health care sustainability, with some demographic and specialty variability. These data support that climate and health education in AMCs provides information that practitioners see as relevant and important.

Patient Comments and Patient Experience Ratings Are Strongly Correlated With Emergency Department Wait Times.

Hospitals and clinicians increasingly are reimbursed based on quality of care through financial incentives tied to value-based purchasing. Patient-centered care, measured through patient experience surveys, is a key component of many quality incentive programs. We hypothesize that operational aspects such as wait times are an important element of emergency department (ED) patient experience. The objectives of this paper are to determine (1) the association between ED wait times and patient experience and (2) whether patient comments show awareness of wait times. This is a cross-sectional observational study from January 1, 2019, to December 31, 2020, across 16 EDs within a regional health care system. Patient and operations data were obtained as secondary data through internal sources and merged with primary patient experience data from our data analytics team. Dependent variables are (1) the association between ED wait times in minutes and patient experience ratings and (2) the association between wait times in minutes and patient comments including the term wait (yes/no). Patients rated their "likelihood to recommend (LTR) an ED" on a 0 to 10 scale (categories: "Promoter"=9-10, "Neutral"=7-8, or "Detractor"=0-6). Our aggregate experience rating, or Net Promoter Score (NPS), is calculated by the following formula for each distinct wait time (rounded to the nearest minute): NPS=100* (# promoters - # detractors)/(# promoters+ # neutrals+ # detractors). Independent variables for patient age and gender and triage acuity, were included as potential confounders. We performed a mixed-effect multivariate ordinal logistic regression for the rating category as a function of 30minutes waited. We also performed a logistic regression for the percentage of patients commenting on the wait as a function of 30minutes waited. Standard errors are adjusted for clustering between the 16 ED sites. A total of 50 833 unique participants completed an experience survey, representing a response rate of 8.1%. Of these respondents, 28.1% included comments, with 10.9% using the term "wait." The odds ratio for association of a 30-minute wait with LTR category is 0.83 [0.81, 0.84]. As wait times increase, the odds of commenting on the wait increase by 1.49 [1.46, 1.53]. We show policy-relevant bubble plot visualizations of these two relationships. Patients were less likely to give a positive patient experience rating as wait times increased, and this was reflected in their comments. Improving on the factors contributing to ED wait times is essential to meeting health care systems' quality initiatives.

Keeping Land in Grass: Re-Enrollment Motivations with the Environmental Quality Incentive Program after the Conservation Reserve Program

Summary We present data from producers in the upper Great Plains of the US for whom at least one Conservation Reserve Program (CRP) contract expired in the last seven years. The survey covered two groups, one with a retired CRP contract and a second with a retired CRP contract who then enrolled in the Environmental Quality Incentives Program (EQIP) program. Most respondents at least tried to re-enroll into CRP, many unsuccessfully. The CRP group primarily moved to crops on the former CRP land, while EQIP respondents focused on cattle and grazing. Awareness of the EQIP program on the part of the CRP group was only 58%. We compared groups regarding what they considered doing with the land at the end of their respective programs, CRP and EQIP. We examined group differences in motivations and attitudes and found evidence of convergence. We also evaluated these differences using effect size statistics to determine their importance to our overall questions. Our overall conclusion is that the groups have a long history of program participation and there is little difference between them in both their motivation to participate and willingness to do so in the future.

Discerning the process of cultivated land governance transition in China since the reform and opening-up-- Based on the multiple streams framework

Cultivated land is a key resource for human survival and development. Understanding what has promoted the cultivated land governance transition (CLGT) is enlightening to improve cultivated land governance (CLG), then cope with the problems closely related to cultivated land that challenge the sustainable development of human societies, of critical importance. Based on the concept of transition, this paper constructs a theoretical model of the CLGT in China, designs an evaluation index system of CLG, and uses the elbow-kmeans method to identify the cycle and turning points of the CLGT in China from the reform and opening-up to 2020. Then, it introduces the multiple streams framework to summarize the paths of the CLGT. The results indicate that the curve of the CLGT in China shows a "W-shape", including two transition cycles in 1984–1999 and 1999–2020 and two turning points in 1989 and 2003. The first CLGT in China is a demand-induced passive transition, and the second CLGT is a supply-led initiative transition. There are three paths promoting the CLGT, namely, the institutional path, the emergency path and the reconstruction path. The positive benefits of the first two paths counteract the negative impact of the problem stream and halt the decline in CLG output, and the third path promotes the CLG output increase. Finally, China's CLG has not yet achieved SDG 12. This paper recommends the establishment of a CLG early warning platform and the launch of a Cultivated Land Environmental Quality Incentive Program to promote an increase in the output of CLG in China, and ultimately achieve the Sustainable Development Goals.

Experience incentivizing reduction of racial and ethnic disparities in a Medicaid hospital quality incentive program.

We aimed to describe the experience of a state Medicaid agency incentivizing reduction of racial and ethnic disparities in a hospital quality incentive program (QIP). Retrospective review of a decade of experience implementing a hospital health disparity (HD) composite measure. Observational analysis of programwide trends in missed opportunity rates and between-group variance (BGV) for the HD composite from 2011 to 2020 and subanalysis of 16 metrics included in the HD composite for at least 4 years over the decade. Programwide missed opportunity rates and BGV fluctuated widely from 2011 to 2020, likely due to variation in measures included in the HD composite. When the 16 measures that were included in the HD composite for at least 4 years were collapsed into a hypothetical 4-year period, missed opportunity rates decreased across the 4 consecutive years, from 47% in year 1 to 20% in year 4. Differences among racial and ethnic subgroups also decreased across the 4-year period, as reflected in the BGV decrease from 7.85 × 10-4 in year 1 to 5.10 × 10-4 in year 4. Construction of a composite measure, use of a summary disparity statistic, and measure selection are key considerations in the design and interpretation of equity-focused payment programs. This analysis revealed improved aggregate quality performance and a modest reduction in racial and ethnic disparities for measures included in the HD composite for at least 4 years. Further research is needed to evaluate the association between equity-oriented incentives and health disparities.

Pay-for-performance programs effectiveness in healthcare: the case of the end-stage renal disease quality incentive program.

This paper focuses on Medicare's End-Stage Renal Disease Quality Incentive Program (QIP). QIP aims to promote high-quality services in outpatient dialysis facilities by tying their payments to their performance on pre-specified quality measures. In this paper, employing principal-agent theory, we examine the effectiveness of QIP by exploring the changes in various clinical/operational measures when they become a part of the program as a performance measure. We study five QIP quality measures; two are operational: hospitalization and readmission. And three others are clinical: blood transfusion, hypercalcemia, and dialysis adequacy. Overall, we observe a significant improvement in all QIP quality measures after being included in the program, except for readmission. We recommend adjusting the weight and redesigning the readmission measure for Medicare to incentivize providers to reduce readmission. We also discuss establishing care coordination and employing data-driven clinical decision support systems as opportunities for dialysis facilities to improve the care delivery process.

Deprescribing the Kt/V Target for Peritoneal Dialysis in the United States: The Path Toward Adopting International Standards for Dialysis Adequacy.

Deprescribing the Kt/V Target for Peritoneal Dialysis in the United States: The Path Toward Adopting International Standards for Dialysis Adequacy.

Mortality Risk of Patients Treated in Dialysis Facilities with Payment Reductions under ESRD Quality Incentive Program.

The Centers for Medicare & Medicaid Services End-Stage Renal Disease Quality Incentive Program (ESRD QIP) measures quality of care delivered by dialysis facilities and imposes Medicare payment reductions for quality lapses. We assessed the association between payment reductions and patient mortality, a quality indicator not included in the ESRD QIP measure set. Association between mortality and ESRD QIP facility payment reduction based on the year of performance was expressed as the unadjusted rate and patient case-mix-adjusted hazard ratio. We also measured association between mortality and 1-year changes in payment reductions. Retrospective patient cohorts were defined by their treating dialysis facility on the first day of each year (2010-2018). Facility performance resulted in payment reductions for 5%-42% of dialysis facilities over the 9 study years. Patients experienced progressively higher mortality at each payment reduction level. Across all years, unadjusted mortality was 17.3, 18.1, 18.9, 20.3, and 23.9 deaths per 100 patient-years for patients in facilities that received 0%, 0.5%, 1%, 1.5%, and 2% payment reductions, respectively. The adjusted hazard ratio showed a similar stepwise pattern by the level of payment reduction: 1.0 (reference), 1.08 (95% confidence interval [CI], 1.07 to 1.09), 1.15 (95% CI, 1.13 to 1.16), 1.19 (95% CI, 1.16 to 1.21), and 1.34 (95% CI, 1.29 to 1.39). Strength of the association increased from 2010 to 2016. Patients treated in facilities that improved over 1 year generally experienced lower mortality; patients in facilities that performed worse on ESRD QIP measures generally experienced higher mortality. Patient mortality was associated with ESRD QIP facility payment reductions in dose-response and temporal patterns.

Defining Quality While Addressing Equity among Patients with Kidney Failure in the United States.

1Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 2Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania 3Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania 4Nephrology Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 5Harvard Medical School, Boston, Massachusetts 6Office of the Chief Medical Officer, Brigham and Women's Hospital, Boston, Massachusetts Correspondence: Dr. Yuvaram N.V. Reddy, 3400 Spruce Street, Renal Offices, 1 Founders, Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA 19104. Email: [email protected] Published online ahead of print. Publication date available at www.cjasn.org. See related article, “Mortality Risk of Patients Treated in Dialysis Facilities with Payment Reductions under ESRD Quality Incentive Program,” on pages 356–362.

Missouri natural resource professionals share key insights for supporting agroforestry practices through cost-share funding available from USDA conservation programs

Abstract Agroforestry plantings offer a promising ecologically based solution to address agricultural resource concerns while simultaneously achieving conservation goals, because they provide multiple benefits including reduced soil erosion, decreased nutrient runoff, increased biodiversity and greater farm income stability. Despite these benefits, the adoption of agroforestry practices remains low throughout the United States. One approach intended to increase the implementation of these ecologically beneficial practices is to offer financial incentives for landowners. Several USDA conservation programs provide applicant landowners with financial and technical resources to implement approved conservation practices, including tree planting. Missouri offers a unique socio-political context for the application of agroforestry tree plantings in established conservation programs as it is currently the only state with an Environmental Quality Incentives Program fund pool dedicated to agroforestry and woody crop establishment. To gather initial information on the potential for agroforestry in Missouri, seven conservation professionals from prominent agencies, including Natural Resource Conservation Service and University of Missouri Extension, were interviewed. The purpose of these interviews was to gather in-depth knowledge on (1) the current dialogue around trees in conservation programs between natural resource professionals and landowners (2) the relationships between landowners and conservation agencies and (3) the professionals' knowledge of and familiarity with agroforestry practices. Preliminary findings suggest there are misconceptions about the requirements and regulations for conservation programs among landowners and conservation professionals. Another common theme was that conservation agencies face challenges in forming long-term connections with landowners, and they rely primarily on landowners to reach out for assistance. Lastly, conservation professionals are supportive of agroforestry but wish for greater knowledge of the practices before promoting them to landowners. Due to the small sample size of interview participants, these insights provide one perspective into the agroforestry knowledge of natural resource professionals. These initial findings will help direct future research on how well natural resource professionals understand agroforestry concepts and how they are engaging with Missouri farmers to support them in planting trees on their land.

The Role of Social Risk Factors in Dialysis Quality and Patient Outcomes Under a Medicare Quality Incentive Program.

There have been critical improvements in dialysis care and mortality in the last decade. These improvements track with the implementation of the end-stage renal disease (ESRD) Quality Incentive Program (QIP) beginning in 2012, which aligns Medicare payments to dialysis facilities with performance on quality measures. This study explores whether the improvements in dialysis care and patient outcomes under the ESRD QIP have been shared equally among patient groups. Our analyses focus on 4 social risk factors: Black race, Hispanic ethnicity, dual eligibility for Medicare and Medicaid, and rurality. We estimated multivariable regressions using longitudinal Medicare and Consolidated Renal Operations in a Web-Enabled Network data. ESRD QIP payment reductions were more common at dialysis facilities with higher proportions of Black and dual-eligible ESRD patients. Patients with dual eligibility and Black race had persistently worse relative outcomes as the ESRD QIP was implemented. This finding was true for differences in outcomes when comparing patients within and across facilities and was not affected by the addition of specific quality measures to the ESRD QIP measure set. Hispanic patients and patients at rural facilities have generally not had worse outcomes since the start of the ESRD QIP. There is no evidence of widening disparities in dialysis care or patient outcomes across patient groups under the ESRD QIP, which is a longstanding and well-publicized concern with value-based purchasing programs. Relative changes between patient groups since the start of ESRD QIP have not favored any patient group. Many disparities in dialysis quality measures and assessment of dialysis facility payment reductions persist.

Nursing Home COVID Relief Under QIP's Performance-Based Formula: Does Performance Actually Matter, and Should It?

The Quality Incentive Program (QIP) distributed US$2 billion to nursing homes (NHs) that met performance goals primarily related to their COVID-19 infection rates. We examine how QIP affected 15,331 NHs with different facility and community attributes, and the extent to which QIP payments per resident-week (QIP$) were associated with NHs' COVID-related attributes. We find that QIP$ was primarily determined by county (not facility) infection rates. QIP distributed US$2 billion to NHs for months in which they experienced virtually no COVID-19 cases; US$0 was distributed for months in which they experienced more than 300,000 cases. We find that QIP$ was larger for smaller, nonprofit NHs located in more rural and economically distressed communities. Regression analyses reveal that recipients of larger QIP$ maintained greater supplies of personal protective equipment, conducted more staff testing, and limited admissions of infected residents, and that greater staff testing and limited admissions are also associated with NHs' sustained success in receiving QIP payments. Policymakers should consider whether performance-based payment systems are optimal for addressing public health emergencies.

The influence of the Environmental Quality Incentives Program on local water quality

AbstractThe Environmental Quality Incentives Program (EQIP) is the primary conservation program on working agricultural land. The United States Department of Agriculture obligated over $15 billion through EQIP cost‐sharing contracts during the fiscal years 2009–2019. The voluntary nature of the program and the lack of performance assessment have led to speculations regarding the effectiveness of the program in delivering environmental benefits, in particular for improving water quality. This study provides quantitative estimates of the influence of EQIP payments on local water quality at a national scale. We link monitoring station level water quality readings with EQIP contract data and exploit the direction of river flow for identification. The estimated effects of EQIP vary across water quality measures. Estimates indicate that EQIP payments have significantly reduced biochemical oxygen demand and nitrogen, indicating improvements in water quality, but increased total suspended solids, fecal coliform, and phosphorus, suggesting that the implementation of certain conservation practices might have increased soil erosion and pathogen transfer, especially in watersheds with more agricultural production.

Improved Cost Estimates for Agricultural Conservation Practices

HighlightsDeveloped Useful Life Total Cost (ULTC) functions for 23 types of agricultural conservation practices.Derived each cost function from multiple ULTC estimates bracketing a range of design variations and sizes for each agricultural conservation practice.Developed Annual ULTC based on practice life cycle duration.Compared Prioritize, Target, Measure Application costs to ULTC.Recommend using ULTC rather than Prioritize, Target, Measure Application Environmental Quality Incentives Program payment as a cost surrogate. Abstract. The cost to achieve water quality goals is an essential piece of information necessary for assessing whether the expected societal benefits are worthy of investment.Within the United States, taxes generate the “public money” to pay to improve water quality. State and Federal Agencies distribute the public’s money to local governments and landowners as grants and cost-share to implement agricultural conservation practices (“practices”). Comparing the cost to improve water quality and the anticipated public benefit helps inform the investment decision.The lack of a robust method for estimating the cost of practices and developing a Water Quality Strategy hampers the ability to compare cost and benefits. Within Minnesota and North Dakota, Water Quality Practitioners commonly use the Prioritize, Target, Measure Application (PTMApp) to develop strategies to improve water quality. PTMApp utilizes the Environmental Quality Incentives Program payment as a surrogate to estimate practice cost. The Environmental Quality Incentives Program payment is a percentage of the estimated cost to implement a typical practice scenario, excluding the labor to plan, design and permit the practice; inspect the practice during construction; operate and maintain the practice; finance costs; and in most cases forgone income.We addressed the need for estimates of practice cost by developing Useful Life Total Costs (UTLCs) for 23 agricultural conservation practices. Useful Life Total Costs incurred throughout the practice life cycle begin with planning and end with reconstruction to maintain proper function. We developed multiple ULTCs (year 2020) for each practice by bracketing the range of design variations and sizes. Legacy PTMApp costs ranged from 1% to 55% of the UTLC, confirming underestimation of the actual practice costs.Cost functions developed by selecting the best-fit line between the ULTCs and a predominant practice physical characteristic are useful for developing Water Quality Strategies. The cost functions, recently incorporated into PTMApp, considerably improve the ability to estimate the actual cost to achieve water quality goals and societal benefits. Keywords: Benefits, Implementation, Life cycle, Planning, PTMApp, Useful life, Water quality.

Value-Based Care and Kidney Disease: Emergence and Future Opportunities.

The United States health care system has increasingly embraced value-based programs that reward improved outcomes and lower costs. Health care value, defined as quality per unit cost, was a major goal of the 2010 Patient Protection and Affordable Care Act amid high and rising US health care expenditures. Many early value-based programs were specifically designed for patients with end-stage renal disease (ESRD) and targeted toward dialysis facilities, including the ESRD Prospective Payment System, ESRD Quality Incentive Program, and ESRD Seamless Care Organizations. While a great deal of attention has been paid to these ESRD-focused programs, other value-based programs targeted toward hospitals and health systems may also affect the quality and costs of care for a broader population of patients with kidney disease. Value-based care for kidney disease is increasingly relevant in light of the Advancing American Kidney Health initiative, which introduces new value-based payment models: the mandatory ESRD Treatment Choices Model in 2021 and voluntary Kidney Care Choices Model in 2022. In this review article, we summarize the emergence and impact of value-based programs on the quality and costs of kidney care, with a focus on federal programs. Key opportunities in value-based kidney care include shifting the focus toward chronic kidney disease, enhancing population health management capabilities, improving quality measurement, and leveraging programs to advance health equity.

Estimating Northern Bobwhite Density in Privately-Owned Forests Across the Southeast

Rigorous density estimates can inform management, conservation planning, and policy decisions. Northern bobwhite (Colinus virginianus; hereafter, bobwhite) populations are declining throughout their range, including the southeastern United States. Numerous private land conservation initiatives are underway to restore bobwhite populations in these areas, but baseline estimates of density spanning privately owned forests are sparse. This information gap makes it difficult to evaluate the population-level effects of these conservation programs or develop expectations for timelines to reach population targets. We sought to understand baseline densities across privately owned pine forests in the southeastern United States in areas targeted for bobwhite conservation. We sampled 138 pine stands a total of 286 times across Alabama, Florida, Georgia, North Carolina, and South Carolina from 2018 to 2020 using autumn distance sampling point counts. We sampled 110 stands that were either planned or applied U.S. Department of Agriculture, Natural Resources Conservation Service (NRCS) management contracts, specifically Working Lands for Wildlife (WLFW) Northern Bobwhite partnerships or similar Environmental Quality Incentives Program contracts. The WLFW contracts were solely in focal counties identified in the National Bobwhite Conservation Initiative 2.0 plan and by cooperating state wildlife agencies. Contracts were on average 17.4 ha (SD = 27.0). We also sampled 28 areas with extensive (>200 ha) and intensive (e.g., at least every 3 years for the last ~10 years) habitat management for bobwhite. We used a hierarchical distance sampling model to estimate density. Density was lowest in North Carolina and South Carolina. Densities in Alabama were slightly greater, and greatest densities were in Georgia and Florida. However, the majority of observed densities were 2 coveys/40 ha or below, and all were below 4 coveys/40 ha. Large and intensively managed sites on average had 4 times greater density compared to smaller contracts. Specific densities will be reported in the future. Our sampling efforts fill an important information gap regarding densities throughout private lands in the southeastern United States. Our models indicate that bobwhite densities are generally low in pine forests of the Southeast even in counties identified as having the greatest conservation potential. The relatively greater densities at large and intensively managed sites illustrate the need for more intensive landscape-scale planning when implementing private land conservation. Pending research will compare densities at planned and applied NRCS contracts in the context of landscape-scale habitat amount.

Prairie and tree planting tool-PT2 (1.0): a conservation decision support tool for Iowa, USA.

This article overviews the prairie and tree planting tool or PT2 (1.0), an online GIS-based decision support tool for landowners interested in exploring opportunities to plant prairie or trees in and around their farm fields for conservation or production purposes. PT2 1.0 can be found online at: https://pt2.nrem.iastate.edu/. With the PT2 (1.0) users locate farm fields of interest in an online aerial photograph and mapping geographic information system (GIS). Users explore areas they are considering for prairie or tree cover by examining different data layers: soil maps, 2-foot contour topography maps, LiDAR hillshade maps, and a map of current land values based on estimated land rent. Users then utilize scaled dimensional drawing tools to measure and delineate areas of interest for planting trees and or prairie. Once an area is delineated, users select from drop-down menus prairie seed mixes or woody species that are suitable for the soils present, and users can select basic long-term management options. PT2 (1.0) estimates total annualized costs for tree or prairie establishment, long-term management, and opportunity costs (based on area weighted expected soil rent), and factors in the potential benefit of utilizing government cost-share programming, e.g., Environmental Quality Incentive Program or the Conservation Reserve Program. Key data layers are currently functional in Iowa, likewise the financial data underlying the cost analysis are specific to Iowa. PT2 (1.0) is, however, open source and open code and guidance is provided regarding how to access and adapt the data for use in other states.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10457-021-00686-8.

Online Reviews of Hemodialysis Centers Correlate With Medicare and Medicaid Survey Measures of Patient Experience.

Patient experience in outpatient hemodialysis has been shown to be significantly correlated with health outcomes. The current gold standard for assessing patient experience in outpatient hemodialysis is the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS). Online reviews of outpatient hemodialysis centers could potentially serve as an additional source of information regarding patient experience, but they have not been well validated. This study aims to determine whether overall scores and subscores from patient-authored online reviews of outpatient dialysis centers are correlated with current gold standard survey-based measures of patient experience in outpatient hemodialysis. All reviews of hemodialysis centers posted to the online review site CiteHealth.com between March 2008 and October 2019 were collected (1081 reviews of 762 centers). Publicly-available ICH-CAHPS survey summary data and End Stage Renal Disease Quality Incentive Program (ESRD QIP) summary data from May 2016 to October 2019 were obtained from the Dialysis Facility Compare website. Spearman correlation coefficients were calculated between facilities' mean online review overall scores and subscores within a given year and their ICH-CAHPS ratings from the same year. Statistical significance was assessed with a 2-tailed permutation test. A Bonferroni correction for multiple hypothesis testing was applied. The mean "Overall" score from CiteHealth.com had a significant positive correlation with the "Center Care Quality," "Staff," and "Facility" scores from ICH-CAHPS surveys. No significant correlation could be found between the mean "Overall" CiteHealth.com score and any other ICH-CAHPS patient satisfaction metric. There was a significant positive correlation between the mean CiteHealth.com "Center" score and the ICH-CAHPS "Center Care Quality" score, the mean CiteHealth.com "Facility" score and the ICH-CAHPS "Facility" score, and the mean CiteHealth.com "Staff" score and the ICH-CAHPS "Staff" score. No significant correlation was found between the mean CiteHealth.com "Nephrologist" score and the ICH-CAHPS "Nephrologist" score. No significant correlation was found between online review scores and ESRD QIP health outcome measures. Certain components of online reviews are significantly correlated with ICH-CAHPS measures of patient experience. Additionally, online reviews come with narrative comments that can offer specific insights into positive and negative aspects of patient care that cannot always be elucidated by numeric survey questions. Online reviews may have utility as an adjunctive source of information to patient experience surveys such as the ICH-CAHPS.

COVID-19−Associated Decline in the Size of the End-Stage Kidney Disease Population in the United States

COVID-19−Associated Decline in the Size of the End-Stage Kidney Disease Population in the United States

CMS ESRD quality incentive program has not improved patient dialysis vascular access.

Over 468,000 patients in the United States use hemodialysis to manage End Stage Renal Disease (ESRD). The purpose of this study was to determine whether the dialysis access Clinical Performance Measures (CPMs) of Centers for Medicare & Medicaid Services (CMS) ESRD Quality Incentive Program (QIP) have increased arteriovenous fistula (AVF) rates and decreased long-term tunneled hemodialysis catheter (TDC) rates among hemodialysis patients in United States. Retrospective observational study: evaluated reported AVF and long-term TDC rates of 4804 dialysis facilities which reported dialysis access data as part of the ESRD QIP from Payment Year (PY) 2014-2020. Facilities were also sorted by specific additional criteria to examine disparities in dialysis access. Mean AVF rates of included facilities increased from 63.7% in PY 2014 to 67.2% in PY 2016 (p < 0.05), did not change in PY 2017 (p > 0.05), and declined significantly in PY 2018-2020 to 64.1% in PY 2020, near AVF rates at the inception of program. Long-term TDC rates decreased from 10.4% in PY 2014 to 9.88% in PY 2015 (p < 0.05), then increased in PY 2015-PY 2020 to rates higher than at the inception of program, at 11.8% in PY 2020 (p < 0.05). Facilities serving majority Black ZIP Code Tabulation Areas (ZCTAs) or ZCTAs with median income <$45,000 achieved significantly lower AVF rates (p < 0.05) with no significant difference in long-term TDC rates (p > 0.05). AVF rates correlated positively and long-term TDC rates correlated negatively with star rating of facilities (p < 0.05). As one of the first financial QIPs in healthcare, the ESRD QIP has not achieved the stated goals of the CMS to increase AVF access rates above 68% and reduce long-term TDC clinical rates below 10%. Systemic disparities in race, geographic region, economic status, healthcare access, and education of providers and patients prevent successful attainment of goal metrics.