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Minnesota dialysis centers as a group ranked seventh best in the country during 2010 for having a low average mortality rate compared with expectations for patients with advanced kidney disease.
But according to new federal data, dialysis centers in Minnesota didn't fare so well in terms of the quantity of emergency room visits for patients or in terms of hospitalizations.
In one case, the rate of observed-to-expected ER visits for patients at a dialysis center in Minneapolis was 109 percent higher than expected - one of the worst scores in the country.
Those are some of the findings from data being released Tuesday, April 17, by ProPublica, an investigative journalism group in New York City. The Pioneer Press obtained the data from ProPublica before its release to analyze results in Minnesota and Wisconsin, where the average mortality score was 11th best in the nation.
The fact that the average mortality rate among centers here is so low compared with expectations isn't surprising considering "the overall good health of the population and the quality of health care that's available," said Dr. Thomas Nevins, a pediatric nephrologist at the University of Minnesota.
Dialysis is a mechanical treatment that tries to replace critical kidney function in patients with failing kidneys. An estimated 350,000 people in the United States rely on dialysis, often because kidney transplants aren't an option due to the scarcity of donor organs.
Some patients can
receive dialysis treatments at home. Others must visit dialysis centers, where they are hooked to machines that filter waste products from the blood.
The ProPublica data come from dialysis facility reports generated for the federal government by researchers at the University of Michigan. The reports, which were released to the centers themselves in 2011, cover more than 5,000 dialysis centers across the country and include quality scores on dozens of measures for the 2007-2010 period.
ProPublica obtained dialysis facility reports under a Freedom of Information Act request. On Tuesday, the group is publishing online the scores as well as the 19-page long facility reports.
"The single most important part of this is the expected mortality," said Dr. James McCarthy, chair of the division of nephrology and hypertension at the Mayo Clinic in Rochester. "I would want to have some idea of the total impact of the practices in that dialysis unit on my life expectancy."
The Riverside Dialysis of DaVita center in St. Paul, for example, had a 23 percent annual observed death rate among patients treated at the facility between 2007 and 2010, when a 17 percent rate would be expected after adjusting for certain factors.
But the difference was not statistically significant, so "this higher mortality could plausibly be just a chance occurrence," the report states. In other words, the death rate at the facility came in "as expected," said Allen Nissenson, chief medical officer of Denver-based DaVita Inc., one of the nation's largest operators of dialysis centers, with 41 in the Twin Cities and western Wisconsin.
DaVita's center in Northeast Minneapolis earned the dubious distinction of having one of the 15 worst scores in the nation during the 2007-2009 period for the observed-versus-expected rate of ER visits by patients. That same center, at 1049 10th Ave. S.E. in Minneapolis, had an observed-versus-expected hospitalization score between 2007 and 2010 in the bottom 2 percent of centers nationally.
On both counts, Nissenson attributed the performance to other health problems with the disproportionately low-income group of patients treated at the center. These patients typically have worse access to primary care doctors, Nissenson said, so they are more likely to wind up getting care from emergency rooms and hospitals.
The comment points to a shortcoming with the facility reports, said McCarthy, the kidney expert at the Mayo Clinic. The scores don't identify whether hospitalizations or ER visits stem from factors beyond a dialysis center's control, he said.
The reports aren't perfect, agreed Bill Peckham, a dialysis patient in Seattle who has pushed for easier access to the data. Even so, the information in dialysis facility reports can be "very valuable," he said.
Online: To search quality scores for particular dialysis centers, go to TwinCities.com.
Christopher Snowbeck can be reached at 651-228-5479. Follow him at twitter.com/chrissnowbeck.
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