Open AccessFacility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics
Author(s) -
Patrick H. Pun,
Laura P. Svetkey,
Bryan McNally,
Matthew E. Dupre
Publication year - 2022
Publication title -
kidney360
Language(s) - English
Resource type - Journals
ISSN - 2641-7650
DOI - 10.34067/kid.0008092021
Subject(s) - medicine , dialysis , cardiopulmonary resuscitation , emergency medicine , logistic regression , retrospective cohort study , medicaid , staffing , cohort , resuscitation , health care , economics , economic growth , nursing
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 to 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: 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=1,554). 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 to White patients, Black cardiac arrest patients dialyzed in larger facilities (26 vs 21 dialysis stations, p<0.001), facilities with fewer registered nurses per station (0.29 vs 0.33, p<0.001), and facilities with lower quality scores (# citations 6.8 vs 6.3, p=0.04). Facilities treating Black patients cared for a higher proportion of patients with a history of cardiac arrest (41 vs 35%, p<0.001), HIV/Hepatitis B, and Medicaid-enrolled patients (15% vs 11%, p<0.001). Even after accounting for these differences and other covariates, the racial disparity for CPR in Black vs. White patients persisted (OR 0.45, 95% CI 0.27-0.75). 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 multi-faceted approach including developing dialysis clinic-specific protocols for CPR and addressing potential implicit bias.