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Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare.

Publication ,  Journal Article
Cashion, W; Gellad, WF; Sileanu, FE; Mor, MK; Fine, MJ; Hale, J; Hall, DE; Rogal, S; Switzer, G; Ramkumar, M; Wang, V; Bronson, DA; Wilson, M ...
Published in: Clin J Am Soc Nephrol
March 8, 2021

BACKGROUND AND OBJECTIVES: Many kidney transplant recipients enrolled in the Veterans Health Administration are also enrolled in Medicare and eligible to receive both Veterans Health Administration and private sector care. Where these patients receive transplant care and its association with mortality are unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective cohort study of veterans who underwent kidney transplantation between 2008 and 2016 and were dually enrolled in Veterans Health Administration and Medicare at the time of surgery. We categorized patients on the basis of the source of transplant-related care (i.e., outpatient transplant visits, immunosuppressive medication prescriptions, calcineurin inhibitor measurements) delivered during the first year after transplantation defined as Veterans Health Administration only, Medicare only (i.e., outside Veterans Health Administration using Medicare), or dual care (mixed use of Veterans Health Administration and Medicare). Using multivariable Cox regression, we examined the independent association of post-transplant care source with mortality at 5 years after kidney transplantation. RESULTS: Among 6206 dually enrolled veterans, 975 (16%) underwent transplantation at a Veterans Health Administration hospital and 5231 (84%) at a non-Veterans Health Administration hospital using Medicare. Post-transplant care was received by 752 patients (12%) through Veterans Health Administration only, 2092 (34%) through Medicare only, and 3362 (54%) through dual care. Compared with patients who were Veterans Health Administration only, 5-year mortality was significantly higher among patients who were Medicare only (adjusted hazard ratio, 2.2; 95% confidence interval, 1.5 to 3.1) and patients who were dual care (adjusted hazard ratio, 1.5; 95% confidence interval, 1.1 to 2.1). CONCLUSIONS: Most dually enrolled veterans underwent transplantation at a non-Veterans Health Administration transplant center using Medicare, yet many relied on Veterans Health Administration for some or all of their post-transplant care. Veterans who received Veterans Health Administration-only post-transplant care had the lowest 5-year mortality.

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Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

March 8, 2021

Volume

16

Issue

3

Start / End Page

437 / 445

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States Department of Veterans Affairs
  • United States
  • Retrospective Studies
  • Middle Aged
  • Medicare
  • Male
  • Kidney Transplantation
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Cashion, W., Gellad, W. F., Sileanu, F. E., Mor, M. K., Fine, M. J., Hale, J., … Weisbord, S. D. (2021). Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare. Clin J Am Soc Nephrol, 16(3), 437–445. https://doi.org/10.2215/CJN.10020620
Cashion, Winn, Walid F. Gellad, Florentina E. Sileanu, Maria K. Mor, Michael J. Fine, Jennifer Hale, Daniel E. Hall, et al. “Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare.Clin J Am Soc Nephrol 16, no. 3 (March 8, 2021): 437–45. https://doi.org/10.2215/CJN.10020620.
Cashion W, Gellad WF, Sileanu FE, Mor MK, Fine MJ, Hale J, et al. Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare. Clin J Am Soc Nephrol. 2021 Mar 8;16(3):437–45.
Cashion, Winn, et al. “Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare.Clin J Am Soc Nephrol, vol. 16, no. 3, Mar. 2021, pp. 437–45. Pubmed, doi:10.2215/CJN.10020620.
Cashion W, Gellad WF, Sileanu FE, Mor MK, Fine MJ, Hale J, Hall DE, Rogal S, Switzer G, Ramkumar M, Wang V, Bronson DA, Wilson M, Gunnar W, Weisbord SD. Source of Post-Transplant Care and Mortality among Kidney Transplant Recipients Dually Enrolled in VA and Medicare. Clin J Am Soc Nephrol. 2021 Mar 8;16(3):437–445.

Published In

Clin J Am Soc Nephrol

DOI

EISSN

1555-905X

Publication Date

March 8, 2021

Volume

16

Issue

3

Start / End Page

437 / 445

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States Department of Veterans Affairs
  • United States
  • Retrospective Studies
  • Middle Aged
  • Medicare
  • Male
  • Kidney Transplantation
  • Humans
  • Female