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Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics.

Publication ,  Journal Article
Pun, PH; Svetkey, LP; McNally, B; Dupre, ME; CARES Surveillance Group,
Published in: Kidney360
June 30, 2022

BACKGROUND: Cardiac arrest occurs frequently in outpatient dialysis clinics, and immediate cardiopulmonary resuscitation (CPR) provision improves patient outcomes. However, Black patients in dialysis clinics receive CPR from clinic staff less often compared with White patients. We examined the role of dialysis facility resources and patient factors in the observed racial disparity in CPR receipt and automated external defibrillator application. METHODS: This was a retrospective cohort study linking the National Cardiac Arrest Registry to Enhance Survival and Medicare Annual Dialysis Facility Report registries from 2013 to 2017. We identified patients experiencing cardiac arrests within US outpatient dialysis clinics via geolocation matching (N=1554). Differences in facility size, quality, staffing, and patient-related factors were summarized and compared according to patient race. Multilevel multivariable logistic regression models including these factors were used to examine the influence of these factors on the observed disparity in CPR rates between Black and White patients. RESULTS: Compared with White patients, Black cardiac arrest patients dialyzed in larger facilities (26 versus 21 dialysis stations; P<0.001), facilities with fewer registered nurses per station (0.29 versus 0.33; P<0.001), and facilities with lower quality scores (# citations 6.8 versus 6.3; P=0.04). Facilities treating Black patients cared for a higher proportion of patients with a history of cardiac arrest (41% versus 35%; P<0.001), HIV/hepatitis B, and Medicaid-enrolled patients (15% versus 11%; P<0.001). Even after accounting for these differences and other covariates, the racial disparity for CPR in Black versus White patients persisted (OR=0.45; 95% CI, 0.27 to 0.75). The racial disparity in CPR was greater among older patients compared with younger patients (interaction P=0.04). CONCLUSIONS: The racial disparity in CPR delivery within dialysis clinics was not explained by differences in facility resources and quality. Reducing this disparity will require a multifaceted approach, including developing dialysis clinic-specific protocols for CPR and addressing potential implicit bias.

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Published In

Kidney360

DOI

EISSN

2641-7650

Publication Date

June 30, 2022

Volume

3

Issue

6

Start / End Page

1021 / 1030

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Renal Dialysis
  • Medicare
  • Humans
  • Heart Arrest
  • Cardiopulmonary Resuscitation
  • Aged
  • 4202 Epidemiology
  • 3202 Clinical sciences
 

Citation

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Pun, P. H., Svetkey, L. P., McNally, B., Dupre, M. E., & CARES Surveillance Group, . (2022). Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics. Kidney360, 3(6), 1021–1030. https://doi.org/10.34067/KID.0008092021
Pun, Patrick H., Laura P. Svetkey, Bryan McNally, Matthew E. Dupre, and Matthew E. CARES Surveillance Group. “Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics.Kidney360 3, no. 6 (June 30, 2022): 1021–30. https://doi.org/10.34067/KID.0008092021.
Pun PH, Svetkey LP, McNally B, Dupre ME, CARES Surveillance Group. Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics. Kidney360. 2022 Jun 30;3(6):1021–30.
Pun, Patrick H., et al. “Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics.Kidney360, vol. 3, no. 6, June 2022, pp. 1021–30. Pubmed, doi:10.34067/KID.0008092021.
Pun PH, Svetkey LP, McNally B, Dupre ME, CARES Surveillance Group. Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics. Kidney360. 2022 Jun 30;3(6):1021–1030.

Published In

Kidney360

DOI

EISSN

2641-7650

Publication Date

June 30, 2022

Volume

3

Issue

6

Start / End Page

1021 / 1030

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Renal Dialysis
  • Medicare
  • Humans
  • Heart Arrest
  • Cardiopulmonary Resuscitation
  • Aged
  • 4202 Epidemiology
  • 3202 Clinical sciences