By Martin M Barillas

The better rated a kidney dialysis center is, the more likely it is to add a patient to the transplant waitlist, according to researchers, though black patients are the least likely to secure a spot on that waitlist.

Doctors at Brigham and Women’s Hospitals investigated connections between patients, dialysis centers and waitlisting characteristics and applied the rating system of the Dialysis Facility Compare Star Program, created by Medicare. They combined information from the U.S. Renal Data System with ratings from the Star program for the years between 2013 and 2018.

Published in JAMA Network Open, the study found that 5-star facilities were 47 percent more likely than 1-star facilities to get their patients waitlisted for transplantation.

“Historically, quality metric programs have focused on specific sites of care, so our objective was to focus on the continuum of experience for the patient,” said Thomas Tsai of Brigham’s Center for Surgery and Public Health and Harvard Medical School, co-author of the study. “We wanted to know if current quality measurements reflected the full continuum of care, and if patients receiving care at higher-rated centers were more likely to be listed for kidney transplantation.”

The authors also found that black patients were not as likely to be waitlisted as white patients and were more likely to receive care at 1- and 2-star facilities.

Patients requiring a life-saving kidney transplant have to be referred to the waiting list by their dialysis center. Research shows that better-rated centers are more likely to place patients on the waitlist than lower-rated centers, though they are less likely to place black patients than white ones compared with lower-rated centers in urban areas. (Piron Guillaume/Unsplash)

The team found that both urban facilities and nonprofits were much more likely to place patients on a waitlist, despite their finding that urban facilities are more likely to be rated 1 or 2 stars. The researchers hoped that combining waitlisting rates with Dialysis Facility Compare ratings would result in higher referral rates and better quality of care at facilities across the country.

Patients with end-stage kidney disease have kidneys that no longer filter blood effectively. Without treatment, biowaste builds up in the body, requiring dialysis, transplantation or kidney management. The disease is life-threatening and requires quality care after diagnosis, which can also be measured by the Medicare rating system based on nine health statistics including mortality, hospitalizations and blood transfusions.

Patients in need of a kidney transplant must be referred by their dialysis center to the United Network for Organ Sharing national waitlist.

For the study, the researchers used U.S. Renal Data System data to understand how dialysis centers measure the quality of their services. After excluding patients who had already received transplants or went to unrated centers, they recorded 507,581 year-long patient experiences at 6,661 facilities.

“At the end of the day, we’re struggling to empower patients to make good, informed decisions about dialysis facilities,” said lead author Joel Adler of Brigham and Women’s Hospital and a professor at Harvard University. “For patients experiencing this system and deciding based on these quality metrics, it’s crucial that we integrate variables like waitlisting rates, which can radically change patient outcomes.”

Edited by Siân Speakman and Kristen Butler

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