Effect of patient- and center-level characteristics on uptake of home dialysis in Australia and New Zealand: a multicenter registry analysis

Abstract Background Home-based dialysis therapies, home hemodialysis (HHD) and peritoneal dialysis (PD) are underutilized in many countries and significant variation in the uptake of home dialysis exists across dialysis centers. This study aimed to evaluate the patient- and center-level characteristics associated with uptake of home dialysis. Methods The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was used to include incident dialysis patients in Australia and New Zealand from 1997 to 2017. Uptake of home dialysis was defined as any HHD or PD treatment reported to ANZDATA within 6 months of dialysis initiation. Characteristics associated with home dialysis uptake were evaluated using mixed effects logistic regression models with patient- and center-level covariates, era as a fixed effect and dialysis center as a random effect. Results Overall, 54 773 patients were included. Uptake of home-based dialysis was reported in 24 399 (45%) patients but varied between 0 and 87% across the 76 centers. Patient-level factors associated with lower uptake included male sex, ethnicity (particularly indigenous peoples), older age, presence of comorbidities, late referral to a nephrology service, remote residence and obesity. Center-level predictors of lower uptake included small center size, smaller proportion of patients with permanent access at dialysis initiation and lower weekly facility hemodialysis hours. The variation in odds of home dialysis uptake across centers increased by 3% after adjusting for the era and patient-level characteristics but decreased by 24% after adjusting for center-level characteristics. Conclusion Center-specific factors are associated with the variation in uptake of home dialysis across centers in Australia and New Zealand.

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A Discrete Choice Study of Patient Preferences for Dialysis Modalities

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.06830617 ◽

2017 ◽

Vol 13 (1) ◽

pp. 100-108 ◽

Cited By ~ 14

Author(s):

Rachael C. Walker ◽

Rachael L. Morton ◽

Suetonia C. Palmer ◽

Mark R. Marshall ◽

Allison Tong ◽

...

Keyword(s):

United States ◽

New Zealand ◽

Confidence Interval ◽

Discrete Choice ◽

Odds Ratio ◽

Patient Choice ◽

Nursing Support ◽

Home Dialysis ◽

Home Based ◽

Out Of Pocket Costs

Background and objectivesImproved knowledge about factors that influence patient choices when considering dialysis modality could facilitate health care interventions to increase rates of home dialysis. We aimed to quantify the attributes of dialysis care and the tradeoffs that patients consider when making decisions about dialysis modalities.Design, setting, participants, & measurementsWe conducted a prospective, discrete choice experiment survey with random parameter logit analysis to quantify preferences and tradeoffs for attributes of dialysis treatment in 143 adult patients with CKD expected to require RRT within 12 months (predialysis). The attributes included schedule flexibility, patient out of pocket costs, subsidized transport services, level of nursing support, life expectancy, dialysis training time, wellbeing on dialysis, and dialysis schedule (frequency and duration). We reported outcomes using β-coefficients with corresponding odds ratios and 95% confidence intervals for choosing home-based dialysis (peritoneal dialysis or hemodialysis) compared with facility hemodialysis.ResultsHome-based therapies were significantly preferred with the following attributes: longer survival (odds ratio per year, 1.63; 95% confidence interval, 1.25 to 2.12), increased treatment flexibility (odds ratio, 9.22; 95% confidence interval, 2.71 to 31.3), improved wellbeing (odds ratio, 210; 95% confidence interval, 15 to 2489), and more nursing support (odds ratio, 87.3; 95% confidence interval, 3.8 to 2014). Respondents were willing to accept additional out of pocket costs of approximately New Zealand $400 (United States $271) per month (95% confidence interval, New Zealand $333 to $465) to receive increased nursing support. Patients were willing to accept out of pocket costs of New Zealand $223 (United States $151) per month (95% confidence interval, New Zealand $195 to $251) for more treatment flexibility.ConclusionsPatients preferred home dialysis over facility-based care when increased nursing support was available and when longer survival, wellbeing, and flexibility were expected. Sociodemographics, such as age, ethnicity, and income, influenced patient choice.

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Fatherhood and Kidney Replacement Therapy: Analysis of the Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2020.03.020 ◽

2020 ◽

Vol 76 (3) ◽

pp. 444-446

Author(s):

Shilpanjali Jesudason ◽

Alyssa Fitzpatrick ◽

Aarti Gulyani ◽

Christopher E. Davies ◽

Erandi Hewawasam ◽

...

Keyword(s):

New Zealand ◽

Replacement Therapy ◽

Kidney Replacement Therapy ◽

Anzdata Registry

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Covid-19 Pandemic Era: Is It Time To Promote Home Dialysis And Peritoneal Dialysis?

Clinical Kidney Journal ◽

10.1093/ckj/sfab023 ◽

2021 ◽

Author(s):

Mario Cozzolino ◽

Ferruccio Conte ◽

Fulvia Zappulo ◽

Paola Ciceri ◽

Andrea Galassi ◽

...

Keyword(s):

Severe Infection ◽

Human Interaction ◽

World Health ◽

Older Individuals ◽

Home Dialysis ◽

Renal Replacement Therapies ◽

Home Based ◽

Immunologic Diseases ◽

Novel Coronavirus ◽

Health Organization

ABSTRACT The novel coronavirus, called SARS-CoV-2 has been declared a pandemic on March 2020, by the World Health Organization. Older individuals and patients with comorbid conditions such as hypertension, heart disease, diabetes, lung disease, chronic kidney disease (CKD), and immunologic diseases are at higher risk of contracting this severe infection. In particular, patients with advanced CKD constitute a vulnerable population and a challenge in the prevention and control of the disease. Home-based renal replacement therapies offer opportunity to manage patients remotely, thus reducing the likelihood of infection due to direct human interaction. Patients are seen less frequently, limiting the close interaction between patients and healthcare workers who may contract and spread the disease. On the other hand, while home dialysis is reasonable selection at his time due to the advantage of isolation of patients, measures must be assured to implement the program. Despite its logistical benefits, outpatient hemodialysis also presents certain challenges during times of crises such as COVID 19 pandemic and potentially future ones.

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Abstract 005: A Comparison of Methods for Identifying Hospital Performance Outliers in Cardiac Surgery

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.005 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Xiaoting Wu ◽

Min Zhang ◽

Richard L Prager ◽

Donald S Likosky

Keyword(s):

Logistic Regression ◽

Regression Models ◽

Random Effect ◽

Hospital Performance ◽

Fixed Effect ◽

Logistic Regression Models ◽

Indirect Standardization ◽

Statistical Approaches ◽

Random Effect Models ◽

Direct Standardization

Introduction: A number of statistical approaches have been advocated and implemented to estimate adjusted hospital outcomes for public reporting or reimbursement. Nonetheless, the ability of these methods to identify hospital performance outliers in support of quality improvement has not yet been fully investigated. Methods: We leveraged data from patients undergoing coronary artery bypass grafting surgery between 2012-2015 at 33 hospitals participating in a statewide quality collaborative. We applied 5 different statistical approaches (1: indirect standardization with standard logistic regression models, 2: indirect standardization with fixed effect models, 3: indirect standardization with random effect models, 4: direct standardization with fixed effect models, 5: direct standardization with random effect models) to estimate hospital post-operative pneumonia rates adjusting for patients’ risk. Unlike the standard logistic regression models, both fixed effect and random effect models accounted for hospital effect. We applied each method to each year, and subsequently compared methods in their ability to identify hospital performance outliers. Results: Pneumonia rates ranged from 0 % to 24 %. The standard logistic regression models for 2013-2015 had c-statistics of 0.73-0.75, fixed effect models had c-statistics of 0.81-0.83, and random effect models had c-statistics of 0.80-0.83. Each method differed in its ability to identify performance outliers (Figure 1). In direct standardization, random effect models stabilized the hospital rates by moving the estimated rates toward the average rate, fixed effect models produced larger standard errors of hospital effect (particularly for hospitals with low case volumes). In indirect standardization, the three models showed high agreement on their derived observed: expected ratio (intraclass correlation =0.95). Indirect standardization with fixed effect or random effect models, identified similar hospital performance outliers in each year. Conclusion: The five statistical approaches varied in their ability to identify performance outliers. Given its higher sensitivity to outlier hospitals, indirect standardization methods with fixed or random effect models, may be best suited to support quality improvement activities.

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Cost-effectiveness of home-based care of febrile neutropenia in children with cancer

10.22541/au.163251882.21756689/v1 ◽

2021 ◽

Author(s):

Michelle Tew ◽

Richard De Abreu Lourenco ◽

Joshua Gordon ◽

Karin Thursky ◽

Monica Slavin ◽

...

Keyword(s):

Cost Effectiveness ◽

Febrile Neutropenia ◽

Low Risk ◽

Hospital Treatment ◽

Decision Analytic Model ◽

Children With Cancer ◽

Patient Level ◽

Home Based ◽

Intravenous Antibiotics ◽

Home Based Care

INTRODUCTION Home-based treatment of low-risk febrile neutropenia (FN) in children with cancer with oral or intravenous antibiotics is safe and effective. There are limited data on the economic impact of this model of care. We evaluated the cost-effectiveness of implementing a low-risk FN program, incorporating home-based intravenous antibiotics, in a tertiary pediatric hospital. METHODS A decision analytic model was constructed to compare costs and outcomes of the low-risk FN program, with usual in-hospital treatment with intravenous antibiotics. The program included a clinical decision rule to identify patients at low-risk for severe infection and home-based eligibility criteria using disease, chemotherapy and patient-level factors. Health outcomes (quality-of-life) and probabilities of FN risk classification and home-based eligibility were based on prospectively collected data. Patient-level costs were extracted from hospital records. Cost-effectiveness was expressed as the incremental cost per quality-adjusted life year (QALY). FINDINGS The mean healthcare cost of home-based FN treatment in low-risk patients was A$7,765 per patient compared to A$20,396 for in-hospital treatment (mean difference A$12,632 (95% CI,12,496-12,767)). Overall, the low-risk FN program was the dominant strategy, being more effective (0.0011 QALY (95% CI,0.0011-0.0012)) and less costly. Results of the model were most sensitive to proportion of children eligible for home-based care program. CONCLUSION Compared to in-hospital FN care, the low-risk FN program is cost-effective, with savings arising from cheaper cost of caring for children at home. These savings could increase as more patients eligible for home-based care are included in the program.

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O4C.6 ‘Healthy on the outside, sick on the inside’ -forestry workers, embodiment and biosociality

Occupational and Environmental Medicine ◽

10.1136/oem-2019-epi.101 ◽

2019 ◽

Vol 76 (Suppl 1) ◽

pp. A37.2-A37

Author(s):

Kirsten Lovelock

Keyword(s):

New Zealand ◽

Health Outcomes ◽

Social Groups ◽

The Body ◽

Protective Equipment ◽

Market Prices ◽

Face To Face ◽

Forestry Workers ◽

Specific Factors ◽

Social Entities

Health outcomes for workers in forestry are shaped by a complex range of exposures, including exposures related to the work environment generated by the industry itself and within a natural environment. We understand how the worker experiences these exposures is shaped by a range of contextual factors including external factors such as market prices and legislation; employer specific factors (e.g. pace of work, provision of Personal Protective Equipment (PPE)); to task specific factors (e.g. repetition, worker control). And, health outcomes from these exposures can range from immediate to delayed, and in duration from acute to chronic. This paper draws on a qualitative research project conducted with forestry workers, their contractors and the CEOs of corporate forests in New Zealand and argues that we need to know more if we are to intervene effectively. Face to face interviews and focus groups were conducted with 100 participants at multiple sites throughout New Zealand (Northland, Gisborne, Central North Island, Hawkes Bay, Wanganui and Otago). This paper focuses specifically on the experiential aspects of being a forestry worker and contractor and how the concept of embodiment and bio-sociality is a useful means by which to understand how bodies are produced and reproduced through labour, how labour converts bodies into social entities and that the body is not exclusively in either the biological or social world, rather bodies are made, have social value and the sociality of bodies shapes altered biologies. These concepts allow us to understand why it is that workers self-describe and are described as being ‘healthy on the outside, sick on the inside’ or ‘fit on the outside, sick on the inside’ and to unpack how social groups form around biological identities marked by ill health or illness susceptibility.

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Direct Restorations, Endodontics, and Bleaching: Materials and Techniques Used by General Dentists of New Zealand

International Journal of Dentistry ◽

10.1155/2019/6327171 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Carolina Loch ◽

Jithendra Ratnayake ◽

Arthi Veerasamy ◽

Peter Cathro ◽

Robert Lee ◽

...

Keyword(s):

New Zealand ◽

Resin Composite ◽

Quality Care ◽

Glass Ionomer ◽

New Materials ◽

Home Based ◽

Resin Modified Glass Ionomer ◽

Permanent Molars ◽

General Dentists ◽

Deciduous Molars

Background. To investigate the selection and use of direct restorative materials, endodontic techniques adopted, and approaches to bleaching by general dentists in New Zealand. Methods. A questionnaire comprising 19 sections and 125 questions was distributed via mail to 351 general dentists in New Zealand who were selected, at random, from the Dental Council of New Zealand’s 2016 register. Results. A total of 204 questionnaires were returned, of which 188 were usable. Direct resin composite was the most commonly used material for occlusoproximal cavity restorations in premolars (93.7%) and permanent molars (85.2%). Resin-modified glass ionomer cements (34%) and resin composite materials (31.4%) were more commonly used in the restoration of deciduous molars. Home-based vital bleaching was provided by a significant number of dentists (86%), while only 18% provided practice-based bleaching. Cold lateral condensation was the most commonly used obturation technique (55.8%), and 83% of respondents reported using rubber dam for treatments. Conclusions. The findings from this study indicate that dentists in New Zealand are adapting to new materials and technologies to provide high quality care to their patients. Aesthetic treatments such as bleaching have become an integral part of general dental practice.

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Home Dialysis is Associated with Lower Costs and Better Survival than other Modalities: A Population-Based Study in Ontario, Canada

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00268 ◽

2019 ◽

Vol 39 (6) ◽

pp. 553-561 ◽

Cited By ~ 6

Author(s):

Murray D. Krahn ◽

Karen E. Bremner ◽

Claire de Oliveira ◽

Stephanie N. Dixon ◽

Phil McFarlane ◽

...

Keyword(s):

Healthcare Costs ◽

Cost Effective ◽

Population Based ◽

Dialysis Initiation ◽

Population Based Study ◽

Home Dialysis ◽

Us Dollar ◽

Baseline Characteristics ◽

Survival Differences ◽

High Comorbidity

Background How and where to initiate dialysis are policy challenges with enormous economic and health consequences. Initiating with home hemodialysis (HD) or peritoneal dialysis (PD) may reduce costs and improve outcomes but evidence is conflicting. Methods We conducted a population-based study in patients aged ≥ 18 years who initiated chronic dialysis in the province of Ontario, Canada from 2006 to 2014 ( N = 12,691) using linked administrative data. Patients were grouped by initial modality: facility HD, facility short daily or slow nocturnal (SD/SN) HD, PD, home HD. We estimated publicly-paid healthcare costs (2015 Canadian dollars; 1 = 0.947 US dollar) and survival, from dialysis initiation to March 2015. Results By 5 years after dialysis initiation, mean 30-day costs (as-treated) for patients receiving PD and home HD were 50% and 64% lower, respectively, than for facility HD patients ($11,011). Approximately 50% of costs were unrelated to dialysis, reflecting high comorbidity in these patients. With covariate adjustment, mean 5-year cumulative costs were similar for initiators of home HD and PD ($304,178 and $349,338) and higher for facility HD initiators ($410,981). The highest 5-year unadjusted survival was for home HD patients (80%), followed by PD (52%), SD/SN HD (50%), and facility HD (42%). Conclusions This study in a large cohort over 9 years provides new population-based evidence suggesting that initiating dialysis at home is cost-effective, with lower costs and better survival, than starting with facility HD. Survival differences persisted after adjustment for baseline characteristics but we could not adjust for functional status or severity of comorbidities.

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Obesity is a Risk Factor for Peritonitis in the Australian and New Zealand Peritoneal Dialysis Patient Populations

Peritoneal Dialysis International ◽

10.1177/089686080402400408 ◽

2004 ◽

Vol 24 (4) ◽

pp. 340-346 ◽

Cited By ~ 85

Author(s):

Stephen P. McDonald ◽

John F. Collins ◽

Markus Rumpsfeld ◽

David W. Johnson

Keyword(s):

Risk Factor ◽

Peritoneal Dialysis ◽

New Zealand ◽

Significant Risk ◽

Significant Risk Factor ◽

Peritoneal Dialysis Patient ◽

Normal Weight ◽

Long Term Follow Up ◽

Artery Disease ◽

Anzdata Registry

Objective The aim of the present investigation was to examine the association between body mass index (BMI) and peritonitis rates among incident peritoneal dialysis (PD) patients in a large cohort with long-term follow-up. Design Retrospective observational cohort study of the Australian and New Zealand PD patient population. Setting Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Participants The study included all incident adult patients ( n = 10 709) who received PD in Australia and New Zealand in the 12-year period between 1 April 1991 and 31 March 2003. Patients were classified as obese (BMI ≥ 30 kg/m2), overweight (BMI 25.0 – 29.9 kg/m2), normal weight (20 – 24.9 kg/m2), or underweight (< 20 kg/m2). Main Measurements Time to first peritonitis and episodes of peritonitis per patient-year were recorded over the 12-year period. Results Higher BMI was associated with a shorter time to first peritonitis episode, independent of other risk factors [hazard ratio 1.08 for each 5-kg/m2 increase in BMI, 95% confidence interval (CI) 1.04 – 1.12, p < 0.001]. When peritonitis outcomes were analyzed as episodes of peritonitis per patient-year, these rates were significantly higher among patients with higher BMI: underweight 0.69 episodes/year (95% CI 0.66 – 0.73), normal weight 0.79 (95% CI 0.77 – 0.81), overweight 0.88 (95% CI 0.85 – 0.90), obese 1.06 (95% CI 1.02 – 1.09). Coronary artery disease and chronic lung disease were associated with both shorter time to first peritonitis and higher peritonitis rates, independently of these other factors. There was also a “vintage effect,” with lower peritonitis rates seen among people who commenced dialysis in more recent years. Conclusions Higher BMI at the commencement of renal replacement therapy is a significant risk factor for peritonitis. The mechanisms for this remain undefined.

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