National Healthcare Disparities Report - LDI Health Economist

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Effectiveness of Care Chronic Kidney Disease Importance Mortality Total ESRD deaths (2009) ................................................................................................87,812 (USRDS, 2009) Chapter 2 Chronic Kidney Disease Prevalence Total cases (2007)..............................................................................................................514,642 (NCHS, 2011) Incidence Number of new cases (2007)..........................................................................................110,996 (USRDS, 2009) Cost Total ESRD Medicare program expenditures (2007) ............................................$23.9 billion (USRDS, 2009) Measures The NHQR and NHDR track several measures of management of chronic kidney disease to assess the quality of care provided to renal dialysis patients. A previous core measure, adequacy of dialysis, was retired because it achieved a rate above 95%. Three measures are highlighted here: Findings n Nephrology care before kidney failure. n Use of arteriovenous fistula (AVF) at first outpatient dialysis. n Registration for transplantation. NEW Management: Nephrology Care Before Kidney Failure Early referral to a nephrologist is important for patients with progressive chronic kidney disease approaching kidney failure. Mindful management during the transition to ESRD permits informed selection of renal replacement therapy, placement and maturation of vascular access, and workup for kidney transplantation. Patients who begin nephrology care more than a year before kidney failure are less likely to begin dialysis with a catheter, experience infections related to vascular access, or die during the months after dialysis initiation (USRDS, 2010). 66 National Healthcare Disparities Report, 2011
Effectiveness of Care Figure 2.12. Patients beginning nephrology care more than 12 months before start of dialysis, by race and ethnicity, 2006-2008 50 45 White Black AI/AN API 50 45 Total Non-Hispanic White Hispanic 40 40 35 35 Percent 30 25 20 15 10 5 0 2006 2007 2008 Key: AI/AN = American Indian or Alaska Native; API = Asian or Pacific Islander. Source: National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Renal Data System, 2006-2008. Denominator: New end stage renal disease patients. Percent 30 25 20 15 10 5 0 2006 2007 2008 Chapter 2 Chronic Kidney Disease n In 2008, only 28% of new ESRD patients began nephrology care more than 12 months before start of dialysis (Figure 2.12). n In all years, Blacks and APIs were less likely than Whites and Hispanics were less likely than non- Hispanic Whites to begin nephrology care more than 12 months before start of dialysis. Also, in the NHQR: n In all years, patients ages 0-19, 45-64, 65-74, and 75 and over were more likely to receive nephrology care than patients ages 20-44. Management: Use of Arteriovenous Fistula at First Outpatient Dialysis For people with ESRD, dialysis can accommodate for lost kidney function by balancing minerals and water in the blood and removing waste. Vascular access is needed to reach blood vessels so dialysis can be performed. An AVF is the preferred type of access for most hemodialysis patients for three reasons: It provides adequate blood flow for dialysis, it lasts a long time, and it has a low complication rate compared with other methods. Although there is consensus that AVF should be the primary method of vascular access, AVF utilization has historically been very low. Therefore, the Centers for Medicare & Medicaid Services (CMS) has sought to increase rates of AVF for primary access by forming a nationwide initiative and collaborative effort to increase overall use of AVF. In 2005, the CMS Fistula First Breakthrough Initiative set the goal for national prevalence of AVF at 66%. National Healthcare Disparities Report, 2011 67
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NATIONAL HEALTHCARE DISPARITIES REP
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Acknowledgments The NHQR and NHDR a
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Highlights New this year, the Highl
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Care Coordination Importance Chapte
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U.S. Department of Health and Human
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