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National volume trends of dialysis access maintenance interventions by provider specialty: analysis of the 2009-2014 Medicare 5% sample
JVIR
’
Scientific Session
Monday
’
S65
of causal factors is warranted to optimize outcomes in this diverse and vulnerable patient population.
specialty had no significant impact on post-intervention patency times.
4:12 PM
4:21 PM
Abstract No. 146
Comparative outcomes of percutaneous endovascular dialysis access maintenance interventions by provider specialty: a 5-year longitudinal Medicare study
Abstract No. 147
National volume trends of dialysis access maintenance interventions by provider specialty: analysis of the 2009-2014 Medicare 5% sample
Purpose: To compare utilization and long-term patency rates following percutaneous dialysis access maintenance procedures by interventionist specialty. Materials: A nationally representative cohort of Medicare beneficiaries undergoing their first dialysis access placement in 2009 was identified from the 5% limited data set. We excluded patients with any prior access placement within 2003-2008. Utilization records for this cohort were tracked for 5 years, using which primary patency (PP), post-intervention primary patency (PIPP) and post-intervention secondary patency (PISP) times were calculated. Physician taxonomy data and provider specialty codes were used to classify each repair visit to groups of: Medicine (Med), Surgery (Sgy) and Radiology (Rad). Multivariate survival models were fit using a conditional risk set approach, allowing for evaluation of multiple ordered patency failure events. Models testing the association between provider specialty and patency failure included patient demographic, geographic and health status variables. Results: 2693 patients received index access placement in 2009. 1856 patients (69%) underwent at least one percutaneous repair and 64% died within 5 years. Radiology, Medicine and Surgery accounted for 38%, 32% and 27% of the 10045 total percutaneous repair visits respectively. There were no statistically significant associations between provider specialty and PIPP or PISP. Hispanic beneficiaries (9% Med, 6% Rad, 4% Sgy) and males (58% Med, 53% Rad, 50% Sgy) were treated more often by medicine interventionists. Patient demographics and health status were otherwise similar by specialty groups. Medicine performed the majority of interventions in the office setting (56%), while radiology performed the majority occurring in the inpatient (60%) and emergency (90%) settings. Utilization frequency of angioplasty was highest with Medicine (80% Med, 76% Rad, 68% Sgy), stenting with Surgery (13% Sgy, 11% Rad, 9% Med) and thrombolysis with Radiology (26% Rad, 23% Med, 18% Sgy). Conclusions: Utilization rates of dialysis access maintenance interventions vary by interventionist specialty. Provider
Purpose: Percutaneous dialysis access maintenance interventions are performed by nephrologists, radiologists and surgeons in the office, outpatient and inpatient settings. We aimed to describe national practice patterns; specifically, whether case volume performed by each specialty varied over time, by clinical location or geographic region. Materials: Patients undergoing percutaneous dialysis access maintenance repairs were identified within the Medicare 5% sample using corresponding CPT codes for the study years 2009-2014. Repair visits were assigned to provider specialty groups of Medicine (Med), Surgery (Surg) and Radiology (Rad) using a combination of provider taxonomy data and specialty codes. Trends over time were evaluated using a generalized linear regression model. Results: Radiologists performed the greatest proportion of 95333 total dialysis access maintenance intervention visits (39% Rad, 34% Med, 24% Surg) observed between 2009 to 2014. The number of interventions performed by radiologists decreased slightly over time (42% in 2009 vs 38% in 2014), while those performed by medicine increased proportionally (32% in 2009 vs 36% in 2014). Volume of interventions performed by surgery did not change over the study period (24% in 2009 vs 24% in 2014). Most repair visits occurred in the office setting (55%). Specialty involvement varied considerably by clinical location. Radiologists and surgeons performed interventions most frequently in the outpatient setting (48% Rad, 44% Surg) while Medicine performed the vast majority of interventions (86%) in the office setting. The majority of repairs visits in the South were performed by Medicine (38%). Radiologists were the most frequent providers in all other geographic regions. Conclusions: Radiologists remain the most common providers of percutaneous dialysis access maintenance procedures in the Medicare population nationally, though a small decline occurred in procedure volume between 2009 and 2014. Case volume for each specialty varied by clinical location and geographic region.
1
1
2
1
MONDAY: Scientific Sessions
P. Trivedi , K. Lind , P. Rochon , C. Ray , R. Ryu ; 1 University of Colorado Denver, Aurora, CO; 2University of Illinois Hospital and Health Sciences Center, Chicago, IL
P. Trivedi1, F. Ahmed1, K. Lind1, P. Rochon1, C. Ray2, R. Ryu1; 1University of Colorado Denver, Aurora, CO; 2 University of Illinois Hospital and Health Sciences Center, Chicago, IL
1
’
Scientific Session
Monday
’
S65
of causal factors is warranted to optimize outcomes in this diverse and vulnerable patient population.
specialty had no significant impact on post-intervention patency times.
4:12 PM
4:21 PM
Abstract No. 146
Comparative outcomes of percutaneous endovascular dialysis access maintenance interventions by provider specialty: a 5-year longitudinal Medicare study
Abstract No. 147
National volume trends of dialysis access maintenance interventions by provider specialty: analysis of the 2009-2014 Medicare 5% sample
Purpose: To compare utilization and long-term patency rates following percutaneous dialysis access maintenance procedures by interventionist specialty. Materials: A nationally representative cohort of Medicare beneficiaries undergoing their first dialysis access placement in 2009 was identified from the 5% limited data set. We excluded patients with any prior access placement within 2003-2008. Utilization records for this cohort were tracked for 5 years, using which primary patency (PP), post-intervention primary patency (PIPP) and post-intervention secondary patency (PISP) times were calculated. Physician taxonomy data and provider specialty codes were used to classify each repair visit to groups of: Medicine (Med), Surgery (Sgy) and Radiology (Rad). Multivariate survival models were fit using a conditional risk set approach, allowing for evaluation of multiple ordered patency failure events. Models testing the association between provider specialty and patency failure included patient demographic, geographic and health status variables. Results: 2693 patients received index access placement in 2009. 1856 patients (69%) underwent at least one percutaneous repair and 64% died within 5 years. Radiology, Medicine and Surgery accounted for 38%, 32% and 27% of the 10045 total percutaneous repair visits respectively. There were no statistically significant associations between provider specialty and PIPP or PISP. Hispanic beneficiaries (9% Med, 6% Rad, 4% Sgy) and males (58% Med, 53% Rad, 50% Sgy) were treated more often by medicine interventionists. Patient demographics and health status were otherwise similar by specialty groups. Medicine performed the majority of interventions in the office setting (56%), while radiology performed the majority occurring in the inpatient (60%) and emergency (90%) settings. Utilization frequency of angioplasty was highest with Medicine (80% Med, 76% Rad, 68% Sgy), stenting with Surgery (13% Sgy, 11% Rad, 9% Med) and thrombolysis with Radiology (26% Rad, 23% Med, 18% Sgy). Conclusions: Utilization rates of dialysis access maintenance interventions vary by interventionist specialty. Provider
Purpose: Percutaneous dialysis access maintenance interventions are performed by nephrologists, radiologists and surgeons in the office, outpatient and inpatient settings. We aimed to describe national practice patterns; specifically, whether case volume performed by each specialty varied over time, by clinical location or geographic region. Materials: Patients undergoing percutaneous dialysis access maintenance repairs were identified within the Medicare 5% sample using corresponding CPT codes for the study years 2009-2014. Repair visits were assigned to provider specialty groups of Medicine (Med), Surgery (Surg) and Radiology (Rad) using a combination of provider taxonomy data and specialty codes. Trends over time were evaluated using a generalized linear regression model. Results: Radiologists performed the greatest proportion of 95333 total dialysis access maintenance intervention visits (39% Rad, 34% Med, 24% Surg) observed between 2009 to 2014. The number of interventions performed by radiologists decreased slightly over time (42% in 2009 vs 38% in 2014), while those performed by medicine increased proportionally (32% in 2009 vs 36% in 2014). Volume of interventions performed by surgery did not change over the study period (24% in 2009 vs 24% in 2014). Most repair visits occurred in the office setting (55%). Specialty involvement varied considerably by clinical location. Radiologists and surgeons performed interventions most frequently in the outpatient setting (48% Rad, 44% Surg) while Medicine performed the vast majority of interventions (86%) in the office setting. The majority of repairs visits in the South were performed by Medicine (38%). Radiologists were the most frequent providers in all other geographic regions. Conclusions: Radiologists remain the most common providers of percutaneous dialysis access maintenance procedures in the Medicare population nationally, though a small decline occurred in procedure volume between 2009 and 2014. Case volume for each specialty varied by clinical location and geographic region.
1
1
2
1
MONDAY: Scientific Sessions
P. Trivedi , K. Lind , P. Rochon , C. Ray , R. Ryu ; 1 University of Colorado Denver, Aurora, CO; 2University of Illinois Hospital and Health Sciences Center, Chicago, IL
P. Trivedi1, F. Ahmed1, K. Lind1, P. Rochon1, C. Ray2, R. Ryu1; 1University of Colorado Denver, Aurora, CO; 2 University of Illinois Hospital and Health Sciences Center, Chicago, IL
1