The Impact of Transplant Waitlisting Measures on Dialysis Facilities' Star Ratings
研究了将肾移植等待名单指标加入透析设施星级评分后，36.5%的设施评分发生变化，低社会经济地位设施更可能降星，高社会经济地位设施更可能升星。
OBJECTIVE: To evaluate how adding kidney transplantation waitlisting measures-the Standardized First Kidney Transplant Waitlist Ratio for Incident Dialysis Patients (SWR) and Percentage of Prevalent Patients Waitlisted (PPPW)-affects Dialysis Facility Care Compare Star Ratings. STUDY SETTING AND DESIGN: In this observational, cross-sectional study, we calculated the difference between facilities' published (with waitlisting measures) and counterfactual (without waitlisting measures) Star Ratings. We used multinomial regression to examine associations between Star Rating changes after waitlisting measure inclusion and facility characteristics and calculated corresponding average risk differences. DATA SOURCES AND ANALYTIC SAMPLE: We used comprehensive clinical and administrative data from the Centers for Medicare/Medicaid Services from 2021 to investigate the impact of waitlisting measure addition on Star Ratings. Facility characteristics included demographic and patient mix, area deprivation index (ADI), dialysis organization affiliation, and urbanicity. PRINCIPAL FINDINGS: 36.5% of facilities' ratings changed after waitlisting measures were added. Facility characteristics associated with a higher average risk of Star increase included location in low-ADI (0.091; 95% CI: 0.072, 0.109) or urban areas (0.061; 95% CI: 0.034, 0.087), independent/small dialysis organization affiliation (0.062; 95% CI: 0.041, 0.083), and having more PD patients (0.115; 95% CI: 0.093, 0.138). Characteristics associated with a higher average risk of Star decrease included high-ADI (0.075; 95% CI: 0.054, 0.095) or rural (0.056; 95% CI: 0.028, 0.083) location, large dialysis organization affiliation (0.058; 95% CI: 0.039, 0.078), having more patients with dual Medicare/Medicaid eligibility (0.052; 95% CI: 0.032, 0.071), and having fewer peritoneal dialysis patients (0.100; 95% CI: 0.081, 0.120). CONCLUSIONS: Including waitlisting measures significantly impacts the Star Ratings and captures a new dimension of care quality. Worse socioeconomic status-related facility characteristics were strongly associated with worse Star Rating outcomes. These findings can inform future discussions about risk adjustment among the developers of the SWR and PPPW measures.