Response letter to Dr. Wallace - travel distance and home dialysis rates in the United States.
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ABSTRACT:
SUBMITTER: Prakash S
PROVIDER: S-EPMC4164417 | biostudies-literature | 2014 Sep-Oct
REPOSITORIES: biostudies-literature
Publications
Response letter to Dr. Wallace - travel distance and home dialysis rates in the United States.
Prakash S S Lewis S A SA Sehgal A R AR
Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis 20140901 6
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Project description:There is a broad range of patient travel distances to reach a lung transplant hospital in the United States. Whether patient travel distance is associated with waitlist outcomes is unknown. We present a cohort study of patients listed between January 1, 2006 and May 31, 2017 using the Scientific Registry of Transplant Recipients. Travel distance was measured from the patient's permanent zip code to the transplant hospital using shared access signature URL access to Google Maps, and assessed using multivariable competing risk regression models. There were 22 958 patients who met inclusion criteria. Median travel distance was 69.7 miles. Among patients who traveled > 60 miles, 41.2% bypassed a closer hospital and sought listing at a more distant hospital. In the adjusted models, when compared to patients who traveled ≤60 miles, patients who traveled >360 miles had a 27% lower subhazard ratio (SHR) for waitlist removal (SHR 0.73, 95% confidence interval [CI]: 0.60, 0.89, P = .002), 16% lower subhazard for waitlist death (SHR 0.84; 95% CI 0.73-0.95, P = .07), and 13% increased likelihood for transplant (SHR 1.13, 95% CI: 1.07, 1.20, P < .001). Many patients bypassed the nearest transplant hospital, and longer patient travel distance was associated with favorable waitlist outcomes.
| S-EPMC7775271 | biostudies-literature
Project description: Not available
| S-EPMC7175744 | biostudies-literature
Project description:Purpose of reviewTo discuss the changing landscape of home dialysis in the United States over the past decade, including recent research on clinical outcomes in patient undergoing peritoneal dialysis and home hemodialysis, and to describe the impact of recent payment reforms for patients with end-stage renal disease.Recent findingsAccumulating evidence supports the conclusion that clinical outcomes for patients treated with peritoneal dialysis or home hemodialysis are as good as or better than for patients treated with conventional in-center hemodialysis. The recent implementation of the Medicare-expanded prospective payment system for the care of end-stage renal disease patients has resulted in substantial growth in the utilization of peritoneal dialysis in the United States. Utilization of home hemodialysis has also grown, but the contribution of the expanded prospective payment system to this growth is less certain.SummaryHome dialysis, including peritoneal dialysis and home hemodialysis, represents an important alternative to in-center hemodialysis that is effective and patient-centered. Over the coming decade, the growth in the number of end-stage renal disease patient treated with home dialysis modalities should prompt further comparative and cost-effectiveness research, increased attention to racial and ethnic disparities, and investments in home dialysis education for both patients and providers.Video abstracthttp://links.lww.com/CONH/A13.
| S-EPMC4414038 | biostudies-literature
Project description:BackgroundIn response to a longstanding Federal mandate to minimize the role of geography in access to transplant in the United States, we assessed whether patient travel distance was associated with lung transplant outcomes. We focused on the posttransplant time period, when the majority of patient visits to a transplant center occur.MethodsWe present a cohort study of lung transplants in the United States between January 1, 2006, and May 31, 2017. Travel distance was measured from the patient's permanent home zip code to the transplant center using SAS URL access to GoogleMaps. We leveraged data from the US Census, US Department of Agriculture, and the Economic Innovations Group to assess socioeconomic status. Multivariable Cox models were used to assess graft survival.ResultsWe included 18 128 patients who met the inclusion criteria. Median distance was 69.6 miles. Among patients who traveled >60 miles to reach a transplant center, 41.8% bypassed a closer center and sought care at a more distant center. Patients traveling longer distances sought care at centers with a higher annual transplant volume. In the adjusted Cox Model, patients who traveled >360 miles had a slightly higher risk for posttransplant graft failure than patients traveling ≤60 miles (hazard ratio 1.09; 95% CI, 1.01-1.18), and a higher risk for treated acute rejection (hazard ratio, 1.63; 95% CI, 1.43-1.86).ConclusionsTravel distance was significantly associated with post lung transplant survival. However, this effect was relatively modest. Patient travel distance is an important component of access to lung transplant care.
| S-EPMC7375912 | biostudies-literature
Project description:Variability in transplant rates between different dialysis units has been noted, yet little is known about facility-level factors associated with low standardized transplant ratios (STRs) across the United States End-stage Renal Disease (ESRD) Network regions. We analyzed Centers for Medicare & Medicaid Services Dialysis Facility Report data from 2007 to 2010 to examine facility-level factors associated with low STRs using multivariable mixed models. Among 4098 dialysis facilities treating 305 698 patients, there was wide variability in facility-level STRs across the 18 ESRD Networks. Four-year average STRs ranged from 0.69 (95% confidence interval [CI]: 0.64-0.73) in Network 6 (Southeastern Kidney Council) to 1.61 (95% CI: 1.47-1.76) in Network 1 (New England). Factors significantly associated with a lower STR (p?<?0.0001) included for-profit status, facilities with higher percentage black patients, patients with no health insurance and patients with diabetes. A greater number of facility staff, more transplant centers per 10 000 ESRD patients and a higher percentage of patients who were employed or utilized peritoneal dialysis were associated with higher STRs. The lowest performing dialysis facilities were in the Southeastern United States. Understanding the modifiable facility-level factors associated with low transplant rates may inform interventions to improve access to transplantation.
| S-EPMC4180229 | biostudies-literature
Project description:INTRODUCTION:Motor-vehicle crashes are a leading cause of death among children in the United States, and almost one-fourth of all trips by school-aged children are trips to and from school. This study sought to determine how children (5-18years) travel to and from school and, among those living ?1mile of school, to explore the role of school bus service eligibility on school travel mode. METHODS:We used national 2012 survey data to determine prevalence of usual school travel mode, stratified by distance from school. For those living ?1mile of school, multivariable regression was conducted to assess the association between bus service eligibility and walking or bicycling. RESULTS:Almost half (46.6%) of all children rode in passenger vehicles (PV) to school and 41.8% did so for the trip home. Results were similar among those living ?1mile (48.1%, PV to school; 41.3%, PV to home). Among those living ?1mile, 21.9% and 28.4% of children walked or bicycled to and from school, respectively. Ineligibility for school bus service was strongly associated with walking or bicycling to school [adjusted prevalence ratio (aPR: 5.36; p<0.001)] and from school (aPR: 5.36; p<0.001). CONCLUSIONS:Regardless of distance from school, passenger vehicles were a common mode of travel. For children who live close to school, the role that school bus service eligibility plays in walking or bicycling deserves further consideration. PRACTICAL APPLICATIONS:Given the large proportion of children who use passenger vehicles for school travel, effective interventions can be adopted to increase proper child restraint and seat belt use and reduce crash risks among teen drivers. Better understanding of conditions under which bus service is offered to children who live close to school could inform efforts to improve pedestrian and bicyclist safety for school travel.
| S-EPMC5624310 | biostudies-literature
Project description:The mediation of work practices by information and communication technologies enables knowledge workers to telework from remote non-office locations such as their homes, or to work nomadically from multiple locations in a day. This paper uses data from the American Time Use Survey to explore the relationship between daily work locations and travel in the United States from 2003 to 2017. Outcome variables include travel duration and travel during peak periods. Home is by far the most common non-office work location, but working from other people's homes, cafés/libraries, vehicles, and combinations of multiple locations are also measured. Findings show that working from home only on a day (full-day telework) decreases daily travel duration and increases the likelihood of avoiding peak hour travel for both work and non-work related travel. However, for homeworkers who also conduct work from their workplace on the same day (part-day telework), there is no reduction in daily travel time, and avoiding peak hour travel is limited to work-related travel. Working from other locations such as cafés/libraries or vehicles increases the likelihood of not traveling at peak hours. Findings also indicate that morning peak periods are more affected by work location decisions than evening peak periods. A survival analysis of daily departure times for both full-day and part-day homeworkers provides insight into this mechanism. We conclude on the basis of these findings that demand management policies and peak avoidance incentives would be more effective if they encourage both temporal and spatial flexibility for employees when partnering with regional employers.
| S-EPMC7474569 | biostudies-literature
Project description:Background and objectivesInternational guidelines suggest a target culture-negative peritonitis rate of <15% among patients receiving long-term peritoneal dialysis. Through a pediatric multicenter dialysis collaborative, we identified variable rates of culture-negative peritonitis among participating centers. We sought to evaluate whether specific practices are associated with the variability in culture-negative rates between low- and high-culture-negative rate centers.Design, setting, participants, & measurementsThirty-two pediatric dialysis centers within the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative contributed prospective peritonitis data between October 1, 2011 and March 30, 2017. Clinical practice and patient characteristics were compared between centers with a ≤20% rate of culture-negative peritonitis (low-rate centers) and centers with a rate >20% (high-rate centers). In addition, centers completed a survey focused on center-specific peritoneal dialysis effluent culture techniques.ResultsDuring the 5.5 years of observation, 1113 patients had 1301 catheters placed, totaling 19,025 patient months. There were 620 episodes of peritonitis in 378 patients with 411 catheters; cultures were negative in 165 (27%) peritonitis episodes from 125 (33%) patients and 128 (31%) catheters. Low-rate centers more frequently placed catheters with a downward-facing exit site and two cuffs (P<0.001), whereas high-rate centers had more patients perform dialysis themselves without the assistance of an adult care provider (P<0.001). The survey demonstrated that peritoneal dialysis effluent culture techniques were highly variable across centers. No consistent practice or technique helped to differentiate low- and high-rate centers.ConclusionsCulture-negative peritonitis is a frequent complication of maintenance peritoneal dialysis in children. Despite published recommendations for dialysis effluent collection and culture methods, great variability in culture techniques and procedures exists among individual dialysis programs and respective laboratory processes.
| S-EPMC7863662 | biostudies-literature
Project description:Home dialysis, which comprises peritoneal dialysis (PD) or home hemodialysis (home HD), offers patients with ESRD greater flexibility and independence. Although ESRD disproportionately affects racial/ethnic minorities, data on disparities in use and outcomes with home dialysis are sparse. We analyzed data of patients who initiated maintenance dialysis between 2007 and 2011 and were admitted to any of 2217 dialysis facilities in 43 states operated by a single large dialysis organization, with follow-up through December 31, 2011 (n =: 162,050, of which 17,791 underwent PD and 2536 underwent home HD for ≥91 days). Every racial/ethnic minority group was significantly less likely to be treated with home dialysis than whites. Among individuals treated with in-center HD or PD, racial/ethnic minorities had a lower risk for death than whites; among individuals undergoing home HD, only blacks had a significantly lower death risk than whites. Blacks undergoing PD or home HD had a higher risk for transfer to in-center HD than their white counterparts, whereas Asians or others undergoing PD had a lower risk than whites undergoing PD. Blacks irrespective of dialysis modality, Hispanics undergoing PD or in-center HD, and Asians and other racial groups undergoing in-center HD were significantly less likely than white counterparts to receive a kidney transplant. In conclusion, there are racial/ethnic disparities in use of and outcomes with home dialysis in the United States. Disparities in kidney transplantation evident for blacks and Hispanics undergoing home dialysis are similar to those with in-center HD. Future studies should identify modifiable causes for these disparities.
| S-EPMC4926974 | biostudies-literature
Project description:ImportanceTravel distance to abortion services varies widely in the US. Some evidence shows travel distance affects use of abortion care, but there is no national analysis of how abortion rate changes with travel distance.ObjectiveTo examine the association between travel distance to the nearest abortion care facility and the abortion rate and to model the effect of reduced travel distance.Design, setting, and participantsThis cross-sectional geographic analysis used 2015 data on abortions by county of residence from 1948 counties in 27 states. Abortion rates were modeled using a spatial Poisson model adjusted for age, race/ethnicity, marital status, educational attainment, household poverty, nativity, and state abortion policies. Abortion rates for 3107 counties in the 48 contiguous states that were home to 62.5 million female residents of reproductive age (15-44 years) and changes under travel distance scenarios, including integration into primary care (<30 miles) and availability of telemedicine care (<5 miles), were estimated. Data were collected from April 2018 to October 2019 and analyzed from December 2019 to July 2020.ExposuresMedian travel distance by car to the nearest abortion facility.Main outcomes and measuresUS county abortion rate per 1000 female residents of reproductive age.ResultsAmong the 1948 counties included in the analysis, greater travel distances were associated with lower abortion rates in a dose-response manner. Compared with a median travel distance of less than 5 miles (median rate, 21.1 [range, 1.2-63.6] per 1000 female residents of reproductive age), distances of 5 to 15 miles (median rate, 12.2 [range, 0.5-23.4] per 1000 female residents of reproductive age; adjusted coefficient, -0.05 [95% CI, -0.07 to -0.03]) and 120 miles or more (median rate, 3.9 [range, 0-12.9] per 1000 female residents of reproductive age; coefficient, -0.73 [95% CI, -0.80 to -0.65]) were associated with lower rates. In a model of 3107 counties with 62.5 million female residents of reproductive age, 696 760 abortions were estimated (mean rate, 11.1 [range, 1.0-45.5] per 1000 female residents of reproductive age). If abortion were integrated into primary care, an additional 18 190 abortions (mean rate, 11.4 [range, 1.1-45.5] per 1000 female residents of reproductive age) were estimated. If telemedicine were widely available, an additional 70 920 abortions were estimated (mean rate, 12.3 [range, 1.4-45.5] per 1000 female residents of reproductive age).Conclusions and relevanceThese findings suggest that greater travel distances to abortion services are associated with lower abortion rates. The results indicate which geographic areas have insufficient access to abortion care. Modeling suggests that integrating abortion into primary care or making medication abortion care available by telemedicine may decrease unmet need.
| S-EPMC8261612 | biostudies-literature