Effect of patient solicitation on mortality among patients receiving hemodialysis in Korea
Received 11 March 2019
Accepted for publication 29 May 2019
Published 4 July 2019 Volume 2019:13 Pages 1073—1082
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
Young-Ki Lee,1 Hyung-Yun Choi,2 Kiwon Kim,3 AJin Cho,1 Woo Hun Kang,4 Young Il Choi,5 Dae Joong Kim6
1Department of Internal Medicine, Hallym Kidney Institute, Hallym University College of Medicine, Seoul, Korea; 2Department of Management of Chronic Disease, Korea Centers for Disease Control & Prevention, Cheongju, Chungcheongbuk-do, Korea; 3Department of Internal Medicine, National Cancer Center, Goyang, Gyeonggi-do, Korea; 4Department of Internal Medicine, Samsung Myungin Internal Medicine Clinic, Icheon, Gyeonggi-do, Korea; 5Department of Internal Medicine, Young IL Choi Internal Medicine Clinic, Suwon, Gyeonggi-do, Korea; 6Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background: There is concern that overcompetition and illegal activities such as patient solicitation by some dialysis units may threaten patients’ health in Korea. Therefore, we investigated the effect of nephrologists’ patient-soliciting activity on hemodialysis practices and patients’ survival using the Korean Health Insurance Review and Assessment Service database.
Methods: We selected 19 soliciting hemodialysis facilities and matched them with 19 non-soliciting facilities located nearby to eliminate location bias. Soliciting behavior was defined as the reduction of medical fees or providing money to attract dialysis patients.
Results: A total of 2,231 incident dialysis patients were included and followed for a median of 37.2 months. Soliciting facilities had a lower percentage of nephrologists, a higher average daily number of hemodialysis patients per physician, and a higher number of hemodialysis patients per nurse compared with non-soliciting facilities. Survival analysis showed that the crude mortality was significantly higher in patients treated in soliciting facilities than in those treated in non-soliciting facilities, even after adjustment for the effects of many other independently predictive covariates.
Conclusions: This study demonstrated that in Korea, the overall mortality rate in incident dialysis patients was higher in those attending soliciting facilities than in those attending non-soliciting facilities.
Keywords: solicitation, hemodialysis, survival
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