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Biomedical subjects

R A Rettig

Publications and source records attributed to R A Rettig.

At least 19 recordsLinked to original sources
PubMed2006

Associations between CMS's Clinical Performance Measures project benchmarks, profit structure, and mortality in dialysis units.

Prior studies observing greater mortality in for-profit dialysis units have not captured information about benchmarks of care. This study was undertaken to examine the association between profit status and mortality while achieving benchmarks. Utilizing data from the US Renal Data System and the Centers for Medicare & Medicaid Services' end-stage renal disease (ESRD) Clinical Performance Measures project, hemodialysis units were categorized as for-profit or not-for-profit. Associations with mortality at 1 year were estimated using Cox regression. Two thousand six hundred and eighty-five dialysis units (31,515 patients) were designated as for-profit and 1018 (15,085 patients) as not-for-profit. Patients in for-profit facilities were more likely to be older, black, female, diabetic, and have higher urea reduction ratio (URR), hematocrit, serum albumin, and transferrin saturation. Patients (19.4 and 18.6%) in for-profit and not-for-profit units died, respectively. In unadjusted analyses, profit status was not associated with mortality (hazard ratio (HR)=1.04, P=0.09). When added to models with profit status, the following resulted in a significant association between profit status (for-profit vs not-for-profit) and increasing mortality risk: URR, hematocrit, albumin, and ESRD Network. In adjusted models, patients in for-profit facilities had a greater death risk (HR 1.09, P=0.004). More patients in for-profit units met clinical benchmarks. Survival among patients in for-profit units was similar to not-for-profit units. This suggests that in the contemporary era, interventions in for-profit dialysis units have not impaired their ability to deliver performance benchmarks and do not affect survival.

Ambulatory Care Facilities↗
PubMed2000

The political economy of nephrology.

An issue of Seminars devoted to "The Economics of Nephrology" requires consideration not only of the narrow economic issues affecting the specialty but also the public policies that establish its economic parameters. Some economic issues involve only the balancing of costs and revenues in a dialysis unit. Others turn on the ESRD policies of Medicare. Still others hinge on action by the US Congress and, by definition, are political in character. In nephrology, economics are intertwined with politics, hence the political economy of nephrology.

Humans↗
PubMed1997

Measuring and improving the health status of end stage renal disease patients.

This highlight reports on recent efforts to develop and promote health status measurement instruments for use in dialysis units that treat end-stage renal disease (ESRD) patients, most of whom are covered for all medical services under Medicare. Readers interested in a more detailed discussion of instruments, including associated data collection and data processing aspects, should consult a recently published account, with its extensive references, of four instruments currently being used in dialysis units (Rettig et al., 1997). Those interested in early reports of the clinical utility of such instruments should consult the following references (Kurtin et al., 1992; Meyer et al., 1994; and DeOreo, 1997).

Health Status Indicators↗
PubMed1994

Medical innovation duels cost containment.

The nation's commitment to health cost control will potentially conflict with its deeper commitment to innovation in medical technology--drugs, medical devices, diagnostic and therapeutic procedures, and administrative infrastructure. Medical technology is implicated in increasing health care costs because, on a net basis, it increases the capabilities of medicine. Conceptual, methodological, institutional, and political factors limit the ability to address the potential conflict; these limits must be confronted and addressed if we are to formulate sound policy responses.

Cost Control↗
PubMed1993

A proposal for guidelines for patient acceptance to and withdrawal from dialysis: a follow-up to the IOM report.

The Institute of Medicine Committee for the Study of the Medicare End Stage Renal Disease Program recommended that the nephrology community, patients, and families develop guidelines for decisions to accept patients to and withdraw them from dialysis. This article rebuts the arguments that have been voiced against such guidelines, presents arguments for them, and proposes a mechanism for their development should general agreement to draft such guidelines be reached.

Decision Making↗
PubMed1989

The politics of organ transplantation: a parable of our time.

This paper reviews the historical development of federal government policy for kidney, heart, and liver transplantation. It examines several political dimensions of whole organ transplantation: the role of the print and broadcast media; the management of organ procurement; the certification of transplant centers; the evaluation of new surgical procedures; and the issues of financing, distributive justice, and rationing of scarce medical resources. The author finds that the media, though powerful in affecting transplant policy, have not been subjected to critical analysis. Organ procurement modifications, driven by a need orientation toward closing the gap between actual and desired levels of performance, may have adversely affected performance. The case of liver transplantation suggests the need for improved institutions and mechanisms for evaluating new surgical procedures. Finally, states that confront the need to meet a binding budget-balancing requirement may allocate funds away from expensive medical procedures that benefit the few toward basic services that benefit the many; the Oregon and Virginia Medicaid programs exemplify this point.

Certification↗