Clinical studiesA simple comorbidity scale predicts clinical outcomes and costs in dialysis patients☆
Section snippets
Patients and methods
The study sample included all patients on hemodialysis or peritoneal dialysis at the University of Pittsburgh outpatient dialysis unit from July 1, 1996, to June 30, 1998. Home hemodialysis patients, patients transferred from another country, and patients for whom information could not be obtained were excluded. Patients were observed until the end of the study period, death, transplant, or transfer out of the unit.
Demographic data and information on comorbid conditions were obtained from the
Results
Of the 291 dialysis patients in our unit, 268 patients were studied for a total of 293 patient years (mean [± SD] of 1.1 ± 0.7 years per patient). Two patients transferred their care from another country, information could not be obtained on 6 patients, and 15 patients receiving home hemodialysis were excluded.
The patients’ mean age was 53 ± 16 years (Table 2). Diabetes was the leading cause of end-stage renal disease. Compared with national data from the United States Renal Data System, the
Discussion
The Health Care Financing Administration is exploring the use of capitated payment schemes, rather than the current fee-for-service plans, to control the costs of caring for patients with end-stage renal disease 3, 14. A capitated approach is attractive because a small number of patients account for these costs, and a small number of physicians, usually nephrologists, control nearly all aspects of their care (8). Despite these advantages, there is little experience in capitating the care of
Acknowledgements
We thank Mr. Jeff Rohay of Network 4 for statistical analysis. We acknowledge the critical review and suggestions by Dr. Beth Piraino, Dr. Linda Fried, and Ms. Judith Bernadini.
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Supported by a grant from Dialysis Clinic, Inc. Nashville, Tennessee. Srinivasan Beddhu was recipient of a grant from the Emma Samuel Winters Foundation.