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Patient Care Technician Staffing and Outcomes Among US Patients Receiving In-Center Hemodialysis.
Plantinga, Laura C; Bender, Alexis A; Urbanski, Megan; Douglas-Ajayi, Clarica; Morgan, Jennifer Craft; Woo, Karen; Jaar, Bernard G.
Affiliation
  • Plantinga LC; Division of Rheumatology, Department of Medicine, University of California, San Francisco.
  • Bender AA; Division of Nephrology, Department of Medicine, University of California, San Francisco.
  • Urbanski M; Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia.
  • Douglas-Ajayi C; Division of Transplantation, Department of Surgery, Emory University, Atlanta, Georgia.
  • Morgan JC; National Association of Nephrology Technicians/Technologists, Dayton, Ohio.
  • Woo K; Gerontology Institute, Georgia State University, Atlanta.
  • Jaar BG; Department of Surgery, University of California, Los Angeles.
JAMA Netw Open ; 7(3): e241722, 2024 Mar 04.
Article in En | MEDLINE | ID: mdl-38457178
ABSTRACT
Importance Dialysis patient care technicians (PCTs) play a critical role in US in-center hemodialysis (HD) care, but little is known about the association of PCT staffing with patient outcomes at US HD facilities.

Objective:

To estimate the associations of in-center HD patient outcomes with facility-level PCT staffing. Design, Setting, and

Participants:

This was a retrospective cohort study, with data analysis performed from March 2023 to January 2024. Data on US patients with end-stage kidney disease and their treatment facilities were obtained from the US Renal Data System. Participants included patients (aged 18-100 years) initiating in-center HD between January 1, 2016, and December 31, 2018, who continued receiving in-center HD for 90 days or more and had data on PCT staffing at their initial treating HD facility. Exposure Facility-level patient-to-PCT ratios (number of HD patients divided by the number of PCTs reported by the treating facility in the prior year), categorized into quartiles (highest quartile denotes the highest PCT burden). Main Outcomes and

Measures:

Patient-level outcomes included 1-year patient mortality, hospitalization, and transplantation. Associations of outcomes with quartile of patient-to-PCT ratio were estimated using incidence rate ratios (IRRs) from mixed-effects Poisson regression, with adjustment for patient demographics and clinical and facility factors.

Results:

A total of 236 126 patients (mean [SD] age, 63.1 [14.4] years; 135 952 [57.6%] male; 65 945 [27.9%] Black; 37 777 [16.0%] Hispanic; 153 637 [65.1%] White; 16 544 [7.0%] other race; 146 107 [61.9%] with diabetes) were included. After full adjustment, the highest vs lowest quartile of facility-level patient-to-PCT ratio was associated with a 7% higher rate of patient mortality (IRR, 1.07; 95% CI, 1.02-1.12), a 5% higher rate of hospitalization (IRR, 1.05; 95% CI, 1.02-1.08), an 8% lower rate of waitlisting (IRR, 0.92; 95% CI, 0.85-0.98), and a 20% lower rate of transplant (IRR, 0.80; 95% CI, 0.71-0.91). The highest vs lowest quartile of patient-to-PCT ratio was also associated with an 8% higher rate of sepsis-related hospitalization (IRR, 1.08; 95% CI, 1.03-1.14) and a 15% higher rate of vascular access-related hospitalization (IRR, 1.15; 95% CI, 1.03-1.28). Conclusions and Relevance These findings suggest that initiation of treatment in facilities with the highest patient-to-PCT ratios may be associated with worse early mortality, hospitalization, and transplantation outcomes. These results support further investigation of the impact of US PCT staffing on patient safety and quality of US in-center HD care.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Renal Dialysis / Kidney Failure, Chronic Limits: Female / Humans / Male / Middle aged Language: En Journal: JAMA Netw Open Year: 2024 Document type: Article Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Renal Dialysis / Kidney Failure, Chronic Limits: Female / Humans / Male / Middle aged Language: En Journal: JAMA Netw Open Year: 2024 Document type: Article Country of publication: