The Treatment of Kidney Disease: An Analysis of Medical Care Process, Medical Care Structure, and Patient Outcomes

摘要

The objective of this study was to examine the relationship between medical care process (i.e., physicians' assignment of patients to dialysis settings), medical care structure (i.e., whether a patient dialyzes at home or at a facility), and patient outcomes using end-stage renal disease, its treatment (i.e., hemodialysis), and the patient's concomitant disability as a concrete example. Using data from a national survey of hemodialysis patients, it was found that both medical and nonmedical factors affect patient assignment to dialysis setting. The strongest predictor of assignment to home dialysis was the availability of a dialysis partner. It was found that (1) whites were more likely than nonwhites to dialyze at home and that home patients tended to be married and more highly educated than facility dialysis patients; (2) that patients of low socio-economic status tended to dialyze at the facility, while home patients tended to be of relatively high socio-economic status. Analyses of patient outcomes indicated that for all outcomes but one (i.e., employment status), dialysis setting had no direct or mediating effect once the patient assignment criteria were controlled.