Community health access may ease burden for Medicaid patients, uninsured adults with ESKD
Click Here to Manage Email Alerts
Key takeaways:
- The Northeast census region had the highest concentration of states with health center services.
- Greater community health center penetration was linked to prolonged nephrology care and favorable outcomes.
Greater access to community health centers may improve outcomes for Medicaid recipients and adults without insurance who have end-stage kidney disease, data show.
Amid systematic barriers in health care, “nephrology is unique in that U.S. federal health insurance, Medicare, covers most patients with ESKD irrespective of age or income,” Yoshio N. Hall, MD, MS, academic professor of medicine in nephrology at the University of Washington Kidney Research Institute in Seattle, told Healio. “However, this near-universal coverage does not extend to patients with non-dialysis-dependent kidney disease. As such, most nephrology practices in the U.S. continue to focus their care on patients who require maintenance dialysis.”
While care models exist to address this, Hall said, “there remains an urgent need to incentivize high-quality and high-value nephrology care prior to kidney failure onset.” Researchers conducted a retrospective cohort study with 139,275 adults, aged 18 to 64 years, who were either on Medicaid or uninsured at ESKD onset from 2016 to 2020. They examined how state-level community health center penetration affected ESKD rate, quality of care before ESKD, and survival and placement on a transplant waitlist 1 year after diagnosis.
Researchers gathered population traits of 1,370 Health Resources and Services Administration health centers and 50 states, including Washington D.C., during the study period.
Community health center penetration was defined as the percentage of low-income residents who were health center patients in each state.
States with higher health center penetration had a mean penetration rate of 36% among lower-income patients, according to the findings. The Northeast census region had the highest concentration of states with health center services, and the South census region had the highest proportion of states with low penetration. Rates of diabetes, high blood pressure and obesity were notably lower in states with high health center penetration vs. lower health center penetration, Hall and colleagues noted. There were no significant differences in age- and sex-standardized ESKD rates based on health center penetration, but individual-level analyses showed greater vs. lower penetration was linked to higher likelihood of the following conditions:
- prolonged nephrology care (OR = 1.04; 95% CI, 1.03-1.05);
- arteriovenous fistula or graft use at hemodialysis start (OR = 1.11; 95% CI, 1.09-1.12);
- home dialysis use (OR = 1.04; 95% CI, 1.02-1.05);
- placement on a kidney transplant waitlist at 1 year (OR = 1.19; 95% CI, 1.18-1.21); and
- ESKD survival (OR = 1.06; 95% CI, 1.04-1.07).
At large, higher health center penetration in low-income populations was linked to “greater preparedness for, and better outcomes after, kidney failure onset,” Hall said.
The period “leading up to kidney failure remains a ‘blind spot’ in U.S. health care surveillance because unlike ESKD, there is no national registry for patients with earlier stages of kidney disease. At the very least, our study findings highlight a pressing need to understand, at the patient-level, how community health centers contribute to care for those at risk for, and experiencing, kidney failure,” Hall said.
Collapse
Click Here to Manage Email Alerts