More Provider Visits Do Not Improve Dialysis Vascular Access Outcomes

The frequency of visits to physicians and advanced practitioners by hemodialysis patients had no significant effect on their graft or arteriovenous fistula survival.

Each additional visit with as physician or advanced practitioner per month in the previous 3 months was associated with 13% increased odds of receiving an intervention to preserve vascular access.
Each additional visit with as physician or advanced practitioner per month in the previous 3 months was associated with 13% increased odds of receiving an intervention to preserve vascular access.

More frequent face-to-face visits with a physician or advanced practitioner are associated with more interventions aimed at preserving vascular access in hemodialysis (HD) patients, but they have no significant effect on vascular access survival, new findings suggest.

In a study of 63,488 Medicare beneficiaries receiving HD, Kevin F. Erickson, MD, of the Center for Primary Care and Outcomes Research at Stanford University School of Medicine in Stanford, Calif., and colleagues found that each additional visit with as physician or advanced practitioner per month in the previous 3 months was associated with 13% increased odds of receiving an intervention to preserve vascular access, the primary study outcome, according to a report published online ahead of print in the Clinical Journal of the American Society of Nephrology

Access-preserving interventions included any surgical, diagnostic, or endovascular procedure except for thrombolysis or thrombectomy. Each additional provider visit per month was associated with a 9% reduction in the odds of hospitalization for vascular access-related infection.

The researchers observed no significant association between provider visits and vascular access survival.

Dr. Erickson's group noted that the Centers for Medicare & Medicaid Services in 2004 enacted a physician reimbursement policy that encourages more frequent outpatient HD care. A potential benefit of more frequent physician visits is that they may lead to recognition of vascular access difficulties and the ordering of interventions to preserve or enhance vascular access. In addition, providers might identify and treat vascular access infections before they become severe enough to require hospitalization.

“We highlight that vascular access care is an area where incentives put in place by Medicare do not appear to improve outcomes and may be associated with increased health care utilization,” the authors concluded. “In hemodialysis, novel management strategies or alternative financial incentives will likely be required to improve vascular access outcomes.”

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