Table 2.

Adjusted changes in the distance to care, patients receiving Veterans Health Administration community-based dialysis treatment, and community dialysis facilities providing Veterans Health Administration–financed dialysis care

Veteran Baseline CharacteristicsVeterans Health Administration Community Dialysis Facilities per Veterans Health Administration Medical Center, n=901 Veterans Integrated Service Network QuartersaVeterans Health Administration Community Dialysis Quality: Standardized Hospitalization Rate, n=4784 Veterans Health Administration Medical Center QuartersVeterans Health Administration Community Dialysis Quality: Standardized Mortality Rate, n=4784 Veterans Health Administration Medical Center QuartersVeterans’ Distance to Veterans Health Administration Community Dialysis, miles, n=7,261,246 claims
Estimate95% Confidence IntervalEstimateb95% Confidence IntervalEstimate95% Confidence IntervalEstimate95% Confidence Interval
Shift in intercept in postpolicy period (2011–2016)−4.15(−10.17 to 1.88)0.025(−0.04 to 0.09)0.006(−0.06 to 0.07)−1.23(−3.96 to 1.49)
Indicator for interim period (2009–2010)−0.31(−4.22 to 3.59)0.010(−0.04 to 0.06)−0.006(−0.05 to 0.04)−1.12(−3.11 to 0.87)
Slope of prepolicy quarterly time trend (2006–2008)1.50(0.88 to 2.11)−0.001(−0.01 to 0.00)0.000(−0.01 to 0.00)−0.44(−0.64 to −0.24)
Slope of postpolicy quarterly time trend (2011–2016)0.75(0.35 to 1.16)−0.001(−0.00 to 0.00)−0.002(−0.00 to 0.00)−0.12(−0.16 to −0.07)
Slope differences, pre- to postpolicy0.75(0.72 to 0.77)0.000(−0.00 to 0.00)0.002(−0.00 to 0.00)−0.32(0.28 to 0.36)
  • a Because of small sample sizes in some of the Veterans Health Administration medical center–level outcomes, regression analysis was conducted at the Veterans Integrated Service Network level (this refers to VA health care system regional designations).

  • b Estimates reflect change in outcome after implementation of Veterans Health Administration (VA) payment policies beginning in 2011. These outcomes include number of community dialysis facilities, publicly reported quality of VA Community Care dialysis facilities (observed versus expected standardized hospitalization rate and standardized mortality rate), and veterans’ distance to VA Community Care dialysis facility. Coefficients in the standardized hospitalization and mortality rate regressions represent the quarterly change in participating community dialysis facilities’ reported standardized annual hospitalization or standardized annual mortality rate.