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Results: 1 to 3 of 3

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The possible impact of the US prospective payment system ("bundle") on the growth of peritoneal dialysis.
Golper TA
(2013) Perit Dial Int 33: 596-9
MeSH Terms: Centers for Medicare and Medicaid Services, U.S., Home Care Services, Humans, Peritoneal Dialysis, Prospective Payment System, Renal Dialysis, United States
Added March 19, 2014
0 Communities
1 Members
0 Resources
7 MeSH Terms
Liver transplant center risk tolerance.
Johnson SR, Karp SJ, Curry MP, Barugel M, Rodrigue JR, Mandelbrot DA, Rogers CP, Hanto DW
(2012) Clin Transplant 26: E269-76
MeSH Terms: Adolescent, Adult, Centers for Medicare and Medicaid Services, U.S., Computer Simulation, End Stage Liver Disease, Female, Follow-Up Studies, Graft Survival, Humans, Liver Transplantation, Male, Middle Aged, Monte Carlo Method, Outcome Assessment, Health Care, Risk Assessment, Survival Rate, Tissue and Organ Procurement, United States, Young Adult
Show Abstract · Added May 22, 2014
Recent changes in Center for Medicare & Medicaid Services (CMS) condition for participation, using benchmark volume/outcomes requirements for certification, have been implemented. Consequently, the ability of a transplant center to assess its risk tolerance is important in successful management. An analysis of SRTR data was performed to determine donor/recipient risk factors for graft loss or patient death in the first year. Each transplant performed was then assigned a prospective relative risk (RR) of failure. Using a Monte-Carlo simulation, transplants were selected at random that met the centers' acceptable risk tolerance. Transplant center volume was fixed and its risk tolerance was adjusted to determine the impact on outcomes. The model was run 1000 times on centers with varying volume. The modeling demonstrates that centers with smaller annual volumes must use a more risk taking strategy than larger volume centers to avoid being flagged for CMS volume requirements. The modeling also demonstrates optimal risk taking strategies for centers based upon volume to minimize the probability of being flagged for not meeting volume or outcomes benchmarks. Small volume centers must perform higher risk transplants to meet current CMS requirements and are at risk for adverse action secondary to chance alone.
© 2012 John Wiley & Sons A/S.
0 Communities
1 Members
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19 MeSH Terms
Challenges to enrollment and randomization of the Frequent Hemodialysis Network (FHN) Daily Trial.
Sergeyeva O, Gorodetskaya I, Ramos R, Schiller BM, Larive B, Raimann JG, Ting GO, Eggers PW, Chertow GM, Levin NW, Frequent Hemodialysis Network Trials Group
(2012) J Nephrol 25: 302-9
MeSH Terms: Canada, Centers for Medicare and Medicaid Services, U.S., Humans, Informed Consent, National Institutes of Health (U.S.), Patient Dropouts, Patient Selection, Prospective Studies, Refusal to Participate, Renal Dialysis, Time Factors, Treatment Outcome, United States
Show Abstract · Added February 26, 2014
BACKGROUND - The US National Institutes of Health (NIH) and Centers for Medicare and Medicaid Services (CMS) sponsored a randomized clinical trial comparing six versus three times per week in-center hemodialysis (the Frequent Hemodialysis Network [FHN] Daily Trial), to test the effects of frequent hemodialysis on an array of intermediate outcomes. Herein we report challenges to enrollment and randomization into the trial.
METHODS - Screening and enrollment was tracked at all participating dialysis clinics and specific reasons for dropout after baseline assessment were recorded for all enrolled subjects. Reasons for consent refusal were recorded in a subset of (10 out of 65) sites.
RESULTS - The trial screened 6276 hemodialysis patients on three times weekly hemodialysis in 65 hemodialysis clinics, 3481 (55%) were considered eligible for enrollment, and 3124 (90%) were approached for consent; 378 (12%) consented and 245 were randomized (65% of those enrolled). Prospective subjects chose not to participate primarily because of the anticipated time required for three extra treatments per week and the difficulties in following the protocol.
CONCLUSIONS - Recruitment into the FHN Daily Trial proved challenging but the goal of 250 randomized subjects was almost met.
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1 Members
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13 MeSH Terms