Research Activities, January 2014
The VA uses its own and outsourced dialysis facilities for growing number of veterans with end-stage renal disease
Around 35,000 veterans enrolled in the Veterans Health Administration (VA) have end-stage renal disease (ESRD). To serve its veterans seeking dialysis care for ESRD, the VA operates 74 hospital-based dialysis units that provide both inpatient and outpatient treatments. The VA also relies on a network of non-VA facilities to provide outsourced dialysis care. Costs for the portion of the VA's dialysis care that is outsourced have risen much faster than VA's in-house treatment costs.
A new study shows that patient outcomes (one-year hospitalizations and mortality) also differed by type of setting. The study included veterans in two VA regions who received chronic dialysis care financed by the VA between January 2007 and December 2008. Of 1,388 veterans, 27 percent of whom received dialysis exclusively in the VA, 47 percent in VA-outsourced settings, and 25 percent in dual settings, 48 percent were hospitalized and 12 percent died.
Veterans in VA-outsourced settings were less complex, less likely to be hospitalized, and had shorter hospital stays than veterans receiving dialysis at VA sites. Dual-system dialysis patients had similar likelihood of hospitalization but lower one-year mortality than veterans receiving VA dialysis.
Based on their results, the researchers believe the VA should carefully consider options to reorganize care and improve patient access to care for a growing veteran population with ESRD. This study was supported by AHRQ (HS19479).
See "Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers," by Virginia Wang, Ph.D., Matthew L. Maciejewski, Ph.D., Uptal D. Patel, M.D., and others in the BMC Health Services Research 13(26), pp. 1-9, 2013.