Spatial Analysis of Case-Mix and Dialysis Modality Associations
Background Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent...
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| Veröffentlicht in: | Peritoneal dialysis international 2016-05, Vol.36 (3), p.326-333 |
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| container_title | Peritoneal dialysis international |
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| creator | Phirtskhalaishvili, Tamar Bayer, Florian Edet, Stephane Bongiovanni, Isabelle Hogan, Julien Couchoud, Cécile |
| description | Background
Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities.
Methods
The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients.
Result
The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities.
Conclusions
The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients’ clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients’ clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients’ quality of life, satisfaction, survival, and global efficiency. |
| doi_str_mv | 10.3747/pdi.2015.00003 |
| format | Article |
| fullrecord | <record><control><sourceid>sage_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4881796</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.3747_pdi.2015.00003</sage_id><sourcerecordid>10.3747_pdi.2015.00003</sourcerecordid><originalsourceid>FETCH-LOGICAL-c426t-f0c26a842ac8867568f56a28ef3f38727ba17c22b6226f85f0c0150c2fd1cb583</originalsourceid><addsrcrecordid>eNp1kDtPwzAQxy0EolXpyoiyowS_Yl8XUFWeUisGYLYcJy5GaRzFAdFvj0tLBQO33PB_nO6H0CnBGZNcXrSlyygmeYbjsAM0JJJAyhnmh2iIYSJSEBgGaByCKzDnE8G5hGM0oILLHDgboqunVvdO18m00fU6uJB4m8x0qNKF-0x0UybXbicsfKlr16-TaQjeuBjzTThBR1bXoRrv9gi93N48z-7T-ePdw2w6Tw2nok8tNlRo4FQbACFzATYXmkJlmWUgqSw0kYbSQlAqLOTRH_-KIVsSU-TARuhy29u-F6uqNFXTd7pWbedWulsrr536qzTuVS39h-IARE5ELMi2BabzIXSV3WcJVhuaKtJUG5rqm2YMnP2-uLf_sIuG860h6GWl3vx7FxGG_-q-ANjEfnQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Spatial Analysis of Case-Mix and Dialysis Modality Associations</title><source>MEDLINE</source><source>SAGE Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Phirtskhalaishvili, Tamar ; Bayer, Florian ; Edet, Stephane ; Bongiovanni, Isabelle ; Hogan, Julien ; Couchoud, Cécile</creator><creatorcontrib>Phirtskhalaishvili, Tamar ; Bayer, Florian ; Edet, Stephane ; Bongiovanni, Isabelle ; Hogan, Julien ; Couchoud, Cécile ; REIN registry</creatorcontrib><description>Background
Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities.
Methods
The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients.
Result
The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities.
Conclusions
The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients’ clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients’ clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients’ quality of life, satisfaction, survival, and global efficiency.</description><identifier>ISSN: 0896-8608</identifier><identifier>EISSN: 1718-4304</identifier><identifier>DOI: 10.3747/pdi.2015.00003</identifier><identifier>PMID: 26475843</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Diagnosis-Related Groups ; Female ; France ; Humans ; Kidney Failure, Chronic - epidemiology ; Kidney Failure, Chronic - therapy ; Male ; Middle Aged ; Original ; Renal Dialysis ; Self Care ; Spatial Analysis ; Young Adult</subject><ispartof>Peritoneal dialysis international, 2016-05, Vol.36 (3), p.326-333</ispartof><rights>2016 International Society for Peritoneal Dialysis</rights><rights>Copyright © 2016 International Society for Peritoneal Dialysis.</rights><rights>Copyright © 2016 International Society for Peritoneal Dialysis 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c426t-f0c26a842ac8867568f56a28ef3f38727ba17c22b6226f85f0c0150c2fd1cb583</citedby><cites>FETCH-LOGICAL-c426t-f0c26a842ac8867568f56a28ef3f38727ba17c22b6226f85f0c0150c2fd1cb583</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881796/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881796/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,21817,27922,27923,43619,43620,53789,53791</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26475843$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Phirtskhalaishvili, Tamar</creatorcontrib><creatorcontrib>Bayer, Florian</creatorcontrib><creatorcontrib>Edet, Stephane</creatorcontrib><creatorcontrib>Bongiovanni, Isabelle</creatorcontrib><creatorcontrib>Hogan, Julien</creatorcontrib><creatorcontrib>Couchoud, Cécile</creatorcontrib><creatorcontrib>REIN registry</creatorcontrib><title>Spatial Analysis of Case-Mix and Dialysis Modality Associations</title><title>Peritoneal dialysis international</title><addtitle>Perit Dial Int</addtitle><description>Background
Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities.
Methods
The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients.
Result
The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities.
Conclusions
The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients’ clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients’ clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients’ quality of life, satisfaction, survival, and global efficiency.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Diagnosis-Related Groups</subject><subject>Female</subject><subject>France</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - epidemiology</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Renal Dialysis</subject><subject>Self Care</subject><subject>Spatial Analysis</subject><subject>Young Adult</subject><issn>0896-8608</issn><issn>1718-4304</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kDtPwzAQxy0EolXpyoiyowS_Yl8XUFWeUisGYLYcJy5GaRzFAdFvj0tLBQO33PB_nO6H0CnBGZNcXrSlyygmeYbjsAM0JJJAyhnmh2iIYSJSEBgGaByCKzDnE8G5hGM0oILLHDgboqunVvdO18m00fU6uJB4m8x0qNKF-0x0UybXbicsfKlr16-TaQjeuBjzTThBR1bXoRrv9gi93N48z-7T-ePdw2w6Tw2nok8tNlRo4FQbACFzATYXmkJlmWUgqSw0kYbSQlAqLOTRH_-KIVsSU-TARuhy29u-F6uqNFXTd7pWbedWulsrr536qzTuVS39h-IARE5ELMi2BabzIXSV3WcJVhuaKtJUG5rqm2YMnP2-uLf_sIuG860h6GWl3vx7FxGG_-q-ANjEfnQ</recordid><startdate>20160501</startdate><enddate>20160501</enddate><creator>Phirtskhalaishvili, Tamar</creator><creator>Bayer, Florian</creator><creator>Edet, Stephane</creator><creator>Bongiovanni, Isabelle</creator><creator>Hogan, Julien</creator><creator>Couchoud, Cécile</creator><general>SAGE Publications</general><general>Multimed Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20160501</creationdate><title>Spatial Analysis of Case-Mix and Dialysis Modality Associations</title><author>Phirtskhalaishvili, Tamar ; Bayer, Florian ; Edet, Stephane ; Bongiovanni, Isabelle ; Hogan, Julien ; Couchoud, Cécile</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c426t-f0c26a842ac8867568f56a28ef3f38727ba17c22b6226f85f0c0150c2fd1cb583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Diagnosis-Related Groups</topic><topic>Female</topic><topic>France</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - epidemiology</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Renal Dialysis</topic><topic>Self Care</topic><topic>Spatial Analysis</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Phirtskhalaishvili, Tamar</creatorcontrib><creatorcontrib>Bayer, Florian</creatorcontrib><creatorcontrib>Edet, Stephane</creatorcontrib><creatorcontrib>Bongiovanni, Isabelle</creatorcontrib><creatorcontrib>Hogan, Julien</creatorcontrib><creatorcontrib>Couchoud, Cécile</creatorcontrib><creatorcontrib>REIN registry</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Peritoneal dialysis international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Phirtskhalaishvili, Tamar</au><au>Bayer, Florian</au><au>Edet, Stephane</au><au>Bongiovanni, Isabelle</au><au>Hogan, Julien</au><au>Couchoud, Cécile</au><aucorp>REIN registry</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Spatial Analysis of Case-Mix and Dialysis Modality Associations</atitle><jtitle>Peritoneal dialysis international</jtitle><addtitle>Perit Dial Int</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>36</volume><issue>3</issue><spage>326</spage><epage>333</epage><pages>326-333</pages><issn>0896-8608</issn><eissn>1718-4304</eissn><abstract>Background
Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities.
Methods
The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients.
Result
The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities.
Conclusions
The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients’ clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients’ clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients’ quality of life, satisfaction, survival, and global efficiency.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>26475843</pmid><doi>10.3747/pdi.2015.00003</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Diagnosis-Related Groups Female France Humans Kidney Failure, Chronic - epidemiology Kidney Failure, Chronic - therapy Male Middle Aged Original Renal Dialysis Self Care Spatial Analysis Young Adult |
| title | Spatial Analysis of Case-Mix and Dialysis Modality Associations |
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