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Table 4 The Association of Reimbursement Composition and CKD Quality Indicators

From: Capitated versus fee-for-service reimbursement and quality of care for chronic disease: a US cross-sectional analysis

Reimbursement Composition

Controlled Hypertension (BP < 130/80) in Patients with CKD and Hypertensiona

% or aOR

(95% CI)

(N = 3028)

p-value

Controlled Diabetes (HbA1c < 7%) in Patients with CKD and Diabetesb

% or aOR

(95% CI)

(N = 579)

p-value

ACEi/ARB Use in Patients with CKD and Hypertension

% or aOR

(95% CI)

(N = 3110)

p-value

Statin Use in Patients Age ≥ 50 with CKD

% or aOR

(95% CI)

(N = 3381)

p-value

Unadjusted Prevalence

 Majority Capitation

43%

0.040

78%

0.055

45%

0.994

21%

0.075

 Majority FFS

56%

(ref.)

59%

(ref.)

45%

(ref.)

35%

(ref.)

 Other Revenue Mix

57%

0.829

61%

0.758

40%

0.417

31%

0.557

Model 1

 Majority Capitation

0.61 (0.34–1.08)

0.091

2.57 (0.93–7.10)

0.068

1.02 (0.67–1.54)

0.924

0.55 (0.21–1.42)

0.215

 Majority FFS (ref.)

1

–

1

–

1

–

1

–

 Other Revenue Mix

1.12 (0.66–1.90)

0.667

1.35 (0.67–2.74)

0.401

0.88 (0.50–1.57)

0.671

0.99 (0.58–1.69)

0.957

Model 2

 Majority Capitation

0.65 (0.38–1.11)

0.113

2.87 (1.02–8.06)

0.046

0.77 (0.45–1.32)

0.339

0.75 (0.40–1.38)

0.350

 Majority FFS (ref.)

1

–

1

–

1

–

1

–

 Other Revenue Mix

1.07 (0.62–1.87)

0.804

1.49 (0.74–3.00)

0.260

0.91 (0.50–1.63)

0.744

0.98 (0.59–1.64)

0.948

  1. CKD chronic kidney disease, BP blood pressure, aOR adjusted odds ratio, CI confidence interval, HbA1c Hemoglobin A1c, ACEi Angiotensin converting enzyme inhibitor, ARB angiotensin receptor blocker, NSAID nonsteroidal anti-inflammatory drug
  2. Differences in the unadjusted prevalence of quality indicators across reimbursement types were assessed using unadjusted logistic regression
  3. Model 1 – adjusted for patient characteristics: age, sex, race, comorbidities, total number of chronic conditions, and patient payor type
  4. Model 2 – adjusted for Model 1 + physician/practice characteristics: United States Census Region, metropolitan statistical area, solo practice, physician specialty, physician compensation, practice ownership, and physician employment status
  5. aCKD and hypertension and nonmissing blood pressure reading
  6. bCKD and diabetes and nonmissing HbA1c data