Registered Dietitian Staffing in Dialysis: Impact on Quality Ratings in Mandate and Nonmandate States.

ABSTRACT

OBJECTIVE: Texas is the only state to mandate a patient to full-time equivalent (FTE) registered dietitian (RD) ratio (<125 patientsFTE RD) in dialysis. Little research exists about the relationship between patientFTE RD ratio and quality. Our objectives were to a) examine the effect of the mandate on patientFTE RD ratios in Texas facilities compared to similar nonmandated facilities and b) examine the association between patientFTE RD ratio and the patient rating of staff quality or star rating of the facility. DESIGN AND METHODS: Using data from Dialysis Facility Annual Reports, we excluded facilities with less than 125 patients and matched based on region, chain/profit status, and number of patients, pairing each Texas facility with 2 non-Texas facilities. T-tests for difference of means and chi-square tests were performed to compare facility groups characteristics and assess mandate impact. We used correlation between patientFTE RD ratio and staff quality linearized score, and ANOVA to compare patientFTE RD ratios between the star rating levels. RESULTS: The patientFTE RD ratio was higher in non-Texas than Texas facilities (111.84 ± 40.70 vs 90.80 ± 24.02, P < .01). The Pearson correlation between patientFTE RD ratio and linearized score rating of the dialysis center staff was essentially nonexistent (r = -0.046). We found a trend of higher patientFTE RD ratios in facilities with lower star ratings for quality and staff but no statistical significance. CONCLUSION: The mandate effectively lowered the patientFTE RD ratio in Texas dialysis facilities with over 125 patients, indicating that states considering such a mandate may benefit from implementing it. We found no association between patientFTE RD staffing and quality, either objectively or via patient assessment. Further research should examine whether dialysis facilities are trending toward smaller patient sizes to circumvent staffing mandates and examine the relationship between other professions' staffing ratios and quality.