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Patient Care Technician Staffing in US Hemodialysis Facilities: An Ecological Study.
Plantinga, Laura C; Urbanski, Megan; Hoge, Courtney; Rickenbach, Fran; Douglas-Ajayi, Clarica; Morgan, Jennifer Craft; Bender, Alexis A; Jaar, Bernard G.
Afiliação
  • Plantinga LC; Divisions of Rheumatology and Nephrology, University of California, San Francisco, San Francisco, California.
  • Urbanski M; Departments of Surgery, Emory University, Atlanta, Georgia.
  • Hoge C; Medicine, Emory University, Atlanta, Georgia.
  • Rickenbach F; National Association of Nephrology Technicians/Technologists, Dayton, Ohio.
  • Douglas-Ajayi C; National Association of Nephrology Technicians/Technologists, Dayton, Ohio.
  • Morgan JC; Gerontology Institute, Georgia State University, Atlanta, Georgia.
  • Bender AA; Medicine, Emory University, Atlanta, Georgia.
  • Jaar BG; Departments of Medicine and Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
Kidney Med ; 6(3): 100782, 2024 Mar.
Article em En | MEDLINE | ID: mdl-38419788
ABSTRACT
Rationale &

Objective:

Technicians caring for patients receiving dialysis play a critical, frontline role in the care of patients receiving dialysis in the United States. We sought to provide a comprehensive description and identify correlates of US in-center hemodialysis facility patient care technician staffing patterns. Study

Design:

This was an ecological study. Setting &

Participants:

US facilities providing hemodialysis and reporting patient care technician staffing, identified using the US Renal Data System. Exposures Geography, year, and facility characteristics, including aggregated patient characteristics.

Outcomes:

The study outcome was facility-reported patient-to-patient care technician ratio. Analytical

Approach:

We examined patient-to-patient care technician ratios by US state and over time and also estimated the differences in patient-to-patient care technician ratios associated with facility characteristics, using robust regression with adjustment for facility-level covariates.

Results:

The median patient-to-patient care technician ratio among 6,862 US facilities in 2019 was 9.9 (25th-75th percentiles, 8.2-12.0). Median 2019 patient-to-patient care technician ratios varied substantially by US state and region. There was an overall decline (from 10.6 to 9.9) in median patient-to-patient care technician ratios from 2004 to 2019, whereas the percentage of positions that were unfilled increased (from 2.8% to 3.5%). After adjustment, large dialysis organization status (ß, -0.42; 95% CI, -0.61 to -0.23) and larger facility size (ß, -0.51; 95% CI, -0.68 to -0.33) were associated with lower patient-to-patient care technician ratios. Higher patient-to-registered nurse (ß, 0.80; 95% CI, 0.65-0.94) and patient-to-social worker (ß, 0.53; 95% CI, 0.37-0.70) ratios, presence of licensed vocational nurses or licensed practical nurses at the clinic (ß, 0.83; 95% CI, 0.53-1.12), and location in a poverty area (ß, 0.29; 95% CI, 0.13-0.44) were all associated with higher patient-to-patient care technician ratios. Aggregated patient characteristics of patients treated at the facilities were generally not associated with patient-to-patient care technician ratio after adjustment.

Limitations:

Limited causal inference and potential shifts in staffing after 2019.

Conclusions:

US dialysis facilities vary considerably in their patient care technician staffing by geography, over time, and by various facility characteristics. Further investigation of US patient care technician staffing is warranted and could lead to better, more stable dialysis staffing, improved staff and patient satisfaction, and higher quality of care.
In the United States, patient care technicians play an important role in hemodialysis care. Although ongoing staffing shortages and turnover among other hemodialysis care providers have been described, little is known about US patient care technician staffing. Examining national data reported by dialysis facilities, we found variability in patient care technician staffing by geography, over time (with fewer patients per patient care technician in more recent years), and by various facility characteristics. This information can be used to target staff recruitment and retention interventions at facilities where patient care technician staffing may be more challenging.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article