Dialysis patients receiving treatment from nephrologists with higher patient caseloads have a greater risk of dying prematurely than those receiving care from specialists with lower caseloads, according to a study.
The study, published Aug. 8 on the website of the Journal of the American Society of Nephrology, is described as the first of its kind to examine the association between nephrologist caseload and mortality risk in a large urban U.S. setting.
How many patients a physician sees may affect patients health outcomes, according to background information in the study. To see whether the association is true for kidney specialists, many of whom take care of a large number of dialysis patients, Kamyar Kalantar-Zadeh, MD, MPH, PhD, of the University of California, Irvine, Medical Center and colleagues examined a total of 41 nephrologists with a caseload of 50 to 200 dialysis patients from an urban California region, and retrospectively ranked them according to their dialysis patients mortality rate between 2001 and 2007.
Among the major findings, nephrologists whose dialysis patients had the best survival had a significantly lower patient caseload than nephrologists who patients had the worst survival. For every additional 50 patients cared for by a nephrologist, patients had a 2% higher risk of dying during the study period.
“Additionally, patients treated by nephrologists with the lowest patient mortality rates received higher dialysis doses, had longer sessions and received more kidney transplants,” the authors wrote.
“Our data suggest that patients receiving care from nephrologists with lower caseloads may have greater survival,” Kalantar-Zadeh said in a news release. “Such data may help direct health policies and guidelines more effectively.”
The authors noted that additional studies are needed to confirm findings and to explore mechanisms by which caseload influences patients outcomes. More research is also needed to determine the caseload threshold above which the benefits of increased experience are outweighed by a deterioration in quality of care and patient outcomes.
Study abstract: http://jasn.asnjournals.org/content/early/2013/08/06/ASN.2013020123.abstract.