Treatment Choice and Outcomes for End Stage Renal Disease
Patients with End Stage Renal Disease (ESRD) account for 7% of Medicare fee-for-service spending despite making up less than 1% of the Medicare enrollment. For patients with ESRD, home dialysis, as opposed to facility-based dialysis, is often associated with better outcomes and lower spending. However, home dialysis rates in the US trail behind those of other developed nations. Minorities and low-income individuals are also significantly less likely to use home dialysis, despite being overrepresented among those with ESRD. We study the first year of a nationwide randomized controlled trial that provides financial incentives for dialysis facilities and clinicians to increase home dialysis. We will evaluate the overall impact of the program on home dialysis rates and explore how the impact varies by patient and provider characteristics. Our analyses will shed light on how to improve care for this high-risk population and lay the groundwork for additional analyses of future years of the program.