Research Activities, August 2013
Black and less educated Medicare patients with end-stage kidney disease rate their care worse than others
Patients with end-stage renal disease (ESRD) have complete or nearly complete kidney failure. In the United States, they are eligible for Medicare coverage regardless of age, if they have worked the required amount of time under Social Security. A new study reveals that, on average, Medicare beneficiaries with ESRD report patient experience as least as positive as non-ESRD beneficiaries, except for black and less educated ESRD patients, who report worse care experiences.
Patients with ESRD reported better experiences than other Medicare patients, albeit by small margins, for ratings of care, rating of physician, rating of prescription drug plan, getting prescription drugs, getting needed care, customer service, and getting care quickly. For 7 of 10 care measures, patients with ESRD reported better experiences. Black ESRD patients, but not black Medicare patients as a whole, were more likely than white patients to report poor patient experiences. These differences, however, were small. In addition, the least educated ESRD beneficiaries reported poorer physician communication and care, a pattern that may be particular to ESRD and other chronic conditions that may reflect the complexity of ESRD care.
The researchers believe that educational outreach, efforts targeting physician supply and patient choice, and measurement of patient experiences according to sociodemographic subgroups may reduce these differences. Their findings were based on analysis of national data from the 2009–2010 Medicare Consumer Assessment of Healthcare Providers and Systems Survey. Their study included 823,564 Medicare beneficiaries, 3,794 of whom were ESRD patients. This study was funded by AHRQ (HS16980).
See "Experiences of care among Medicare beneficiaries with ESRD: Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey results," by Charlotte A.M. Paddison, Ph.D., Marc N. Elliott, Ph.D., Amelia M. Haviland, Ph.D., and others in the American Journal of Kidney Disease 61(3), pp. 440-449, 2013.