Characteristics and Performance of Minority-Serving Dialysis Facilities

ObjectiveTo examine the structure, processes, and outcomes of American dialysis facilities that predominantly treat racial-ethnic minority patients. Data Sources/Study SettingSecondary analysis of data from all patients who initiated dialysis during 2005-2008 in the United States. Study DesignIn this retrospective cohort study, we examined the associations of the racial-ethnic composition of the dialysis facility with facility-level survival and achievement of performance targets for anemia and dialysis adequacy. Data Collection/Extraction MethodsWe obtained dialysis facility- and patient-level data from the national data registry of patients with end-stage renal disease. We linked these data with clinical performance measures from the Centers for Medicare and Medicaid Services. Principal FindingsOverall, minority-serving facilities were markedly larger, more often community based, and less likely to offer home dialysis than facilities serving predominantly white patients. A significantly higher proportion of minority-serving dialysis facilities exhibited worse than expected survival as compared with facilities serving predominantly white patients (p<.001 for each). However, clinical performance measures for anemia and dialysis adequacy were similar across minority-serving status. ConclusionsWhile minority-serving facilities generally met dialysis performance targets mandated by Medicare, they exhibited worse than expected patient survival.