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Understanding the Tradeoffs between Travel Burden and Quality of Care for In-Center Hemodialysis Patients (307865)

Jordan Affholter, Kidney Epidemiology and Cost Center, University of Michigan 
Claudia Dahlerus, Kidney Epidemiology and Cost Center, University of Michigan 
Brandon Frye, Kidney Epidemiology and Cost Center, University of Michigan 
Jingya Gao, Kidney Epidemiology and Cost Center, University of Michigan 
Garrett Gremel, Kidney Epidemiology and Cost Center, University of Michigan 
Peisong Han, Kidney Epidemiology and Cost Center, University of Michigan 
Richard A. Hirth, Kidney Epidemiology and Cost Center, University of Michigan 
Yi Li, Kidney Epidemiology and Cost Center, University of Michigan 
Joseph Messana, Kidney Epidemiology and Cost Center, University of Michigan 
*Stephen Salerno, Kidney Epidemiology and Cost Center, University of Michigan 
Lan Tong, Kidney Epidemiology and Cost Center, University of Michigan 
Karen Wisniewski, Kidney Epidemiology and Cost Center, University of Michigan 

Keywords: Access to Care, Quality Measures, Dialysis, Medicare

For End-Stage Renal Disease (ESRD) patients undergoing in-center hemodialysis, treatment necessitates travel to and from a dialysis facility an average of three times per week. This study seeks to identify whether travel burden and quality of care factors are associated with a patient’s choice of dialysis provider. In order to understand the accessibility of care for approximately 500,000 dialysis patients, we geocoded all 7000+ U.S. dialysis facilities using addresses collected from the Centers for Medicare & Medicaid Services (CMS) Dialysis Facility Compare (DFC) site. Individual patient locations were estimated and assigned using a census-derived, population-weighted allocation approach. Travel burden for patients to their closest two facilities were calculated based on the spherical distance between estimated (patient) and exact (facility) coordinates. The DFC also reports information on several clinical quality measures and a global summary of care - the DFC Clinical Quality of Care Star Rating system. We incorporated the proximate facilities’ Star Ratings and urbanicity into a generalized mixed effects model to examine the tradeoff between travel burden and quality of care.