Association of the Comprehensive ESRD Care Model with Treatment Adherence

Poor adherence to scheduled dialysis treatments is common and can cause adverse clinical and economic outcomes. In 2015, the Centers for Medicare and Medicaid Innovation launched the Comprehensive ESRD Care (CEC) Model, a novel modification of the Accountable Care Organization framework. Many model...

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Bibliographic Details
Published in:Kidney360 2022-06, Vol.3 (6), p.1039-1046
Main Authors: Hirth, Richard A, Nahra, Tammie, Segal, Jonathan H, Gunden, Joseph, Marrufo, Grecia, Negrusa, Brighita, Boyer, Gregory, Jiao, Amy, Sleeman, Kathryn, Dahlerus, Claudia, Wiens, Jennifer, Ullman, Darin, Bacon, Kelsey, Strubler, Daniel, Braun, Rebecca, Ackerman, Ariana, Li, Yi
Format: Article
Language:English
Subjects:
Aged
Female
Humans
Kidney Failure, Chronic - epidemiology
Male
Medicaid
Medicare
Original Investigation
Renal Dialysis
Treatment Adherence and Compliance
United States - epidemiology
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Summary:Poor adherence to scheduled dialysis treatments is common and can cause adverse clinical and economic outcomes. In 2015, the Centers for Medicare and Medicaid Innovation launched the Comprehensive ESRD Care (CEC) Model, a novel modification of the Accountable Care Organization framework. Many model participants reported efforts to increase dialysis adherence and promptly reschedule missed treatments. With Medicare databases covering 2014-2019, we used difference-in-differences models to compare treatment adherence among patients aligned to 1037 CEC facilities relative to those aligned to matched comparison facilities, while accounting for their differences at baseline. Using dates of service, we identified patients who typically received three weekly treatments and the days when treatments typically occurred. Skipped treatments were defined as days when the patient was not hospitalized but did not receive an expected treatment, and rescheduled treatments as days when a patient who had skipped their previous treatment received an additional treatment before their next expected treatment date. Patients in the CEC Model had higher odds of attending as-scheduled sessions relative to the comparison group, although the effect was only marginally significant (OR, 1.02; 95% CI, 1.00 to 1.04, =0.08). Effects were stronger among females (OR, 1.03; 95% CI, 1.00 to 1.06, =0.06) than males (OR, 1.01; 95% CI, 0.98 to 1.04, =0.49), and among those aged
ISSN:2641-7650
2641-7650
DOI:10.34067/KID.0006132021