Pay-for-Performance Incentives for Home Dialysis Use and Kidney Transplant

作者：Kalli G. Koukounas, Daeho Kim, Rachel E. Patzer, Adam S. Wilk, Yoojin Lee, Kelsey M. Drewry, Rajnish Mehrotra, Maricruz Rivera‐Hernandez, David J. Meyers, Ankur Shah, Rebecca Thorsness, Christopher H. Schmid, Amal N. Trivedi · 发表于：JAMA Health Forum · 年份：2024 · DOI：10.1001/jamahealthforum.2024.2055 · 被引用次数：18 · 研究领域：Dialysis and Renal Disease Management、Renal Transplantation Outcomes and Treatments、Chronic Kidney Disease and Diabetes

Importance: The Centers for Medicare & Medicaid Services' mandatory End-Stage Renal Disease Treatment Choices (ETC) model, launched on January 1, 2021, randomly assigned approximately 30% of US dialysis facilities and managing clinicians to financial incentives to increase the use of home dialysis and kidney transplant. Objective: To assess the ETC's association with use of home dialysis and kidney transplant during the model's first 2 years and examine changes in these outcomes by race, ethnicity, and socioeconomic status. Design, Setting, and Participants: This retrospective cross-sectional study used claims and enrollment data for traditional Medicare beneficiaries with kidney failure from 2017 to 2022 linked to same-period transplant data from the United Network for Organ Sharing. The study data span 4 years (2017-2020) before the implementation of the ETC model on January 1, 2021, and 2 years (2021-2022) following the model's implementation. Exposure: Receiving dialysis treatment in a region randomly assigned to the ETC model. Main Outcomes and Measures: Primary outcomes were use of home dialysis and kidney transplant. A difference-in-differences (DiD) approach was used to estimate changes in outcomes among patients treated in regions randomly selected for ETC participation compared with concurrent changes among patients treated in control regions. Results: The study population included 724 406 persons with kidney failure (mean [IQR] age, 62.2 [53-72] years; 42.5% female...