Dialysis Facility Characteristics: Comparison Between Large and Small Chain Organizations

Background: Dialysis is the cornerstone treatment for patients with end-stage renal disease (ESRD). Two corporations deliver 78% of dialysis care in the US. Both corporations operate over 2,500 centers, whilst the next largest operates less than 400 centers. Despite the overwhelming market share of two corporations, no studies have compared centers operated by large (>1000 facilities) and small (<1000 facilities) chain organizations. We aimed to cross-sectionally compare facility characteristics, patient demographics, and outcomes between large and small chain corporations. Methods: Dialysis facility and characteristic information was acquired from the Centers for Medicare and Medicaid Services. Facilities without a complete report of variables, as included in Table 1, were excluded. Patient characteristics included demographics, insurance type and comorbidities. Outcomes included mortality, infections, and Kt/V values. We used Mann-Whitney U comparison at significance level 0.05 with Bonferroni correction. Results: A comparison of 959 LC and 267 SC facilities is presented in Table 1. LC and SC patients had similar ages, racial distribution, and comorbidity profile. LC facilities had more full-time social workers and dieticians per patient. LC patients had lower infection rates (0.3% vs. 0.4%, p<0.001). LC hemodialysis and peritoneal dialysis patients were likelier to have Kt/V greater than 1.2 (98.0% vs. 97.0%, p<0.001) and 1.7 (95.0% vs. 92.0%, p<0.001), respectively. Conclusion: Given the preminence of two corporations in dialysis, a comparison of LC and SC facilities is essential.We determined LCs patients were more likely to receive efficacious treatment and less likely to acquire serious infections. LC facilities have the option to better streamline operations with more ancillary staff , which may facilitate better outcomes at LC facilities. We found that LC facilities provide more effective care than SC facilities. However, we recommend further monitoring and expansion of patient outcome incentives.Table 1