Ongoing changes to reimbursement of United States dialysis care may increase the risk of dialysis facility closures. Closures may be particularly detrimental to the health of patients receiving dialysis, who are medically complex and clinically tenuous.

We used two separate analytic strategies—one using facility-based matching and the other using propensity score matching—to compare health outcomes of patients receiving in-center hemodialysis at United States facilities that closed with outcomes of similar patients who were unaffected. We used negative binomial and Cox regression models to estimate associations of facility closure with hospitalization and mortality in the subsequent 180 days.

We identified 8386 patients affected by 521 facility closures from January 2001 through April 2014. In the facility-matched model, closures were associated with 9% higher rates of hospitalization (relative rate ratio [RR], 1.09; 95% confidence interval [95% CI], 1.03 to 1.16), yielding an absolute annual rate difference of 1.69 hospital days per patient-year (95% CI, 0.45 to 2.93). Similarly, in a propensity-matched model, closures were associated with 7% higher rates of hospitalization (RR, 1.07; 95% CI, 1.00 to 1.13; P=0.04), yielding an absolute rate difference of 1.08 hospital days per year (95% CI, 0.04 to 2.12). Closures were associated with nonsignificant increases in mortality (hazard ratio [HR], 1.08; 95% CI, 1.00 to 1.18; P=0.05 for the facility-matched comparison; HR, 1.08; 95% CI, 0.99 to 1.17; P=0.08 for the propensity-matched comparison).

Patients affected by dialysis facility closures experienced increased rates of hospitalization in the subsequent 180 days and may be at increased risk of death. This highlights the need for effective policies that continue to mitigate risk of facility closures.

美国透析治疗报销的持续变化可能会增加透析设施关闭的风险。关闭可能特别不利于接受透析的患者的健康，这些患者在医学上很复杂并且在临床上很脆弱。

我们使用了两种不同的分析策略——一种使用基于设施的匹配，另一种使用倾向得分匹配——来比较在关闭的美国设施中接受中心血液透析的患者的健康结果与未受影响的类似患者的结果。我们使用负二项式和 Cox 回归模型来估计设施关闭与随后 180 天内的住院和死亡率之间的关联。

从 2001 年 1 月到 2014 年 4 月，我们确定了 8386 名患者受到 521 家设施关闭的影响。在设施匹配模型中，关闭与住院率高 9% 相关（相对比率 [RR]，1.09；95% 置信区间 [95% CI]，1.03 至 1.16），产生的绝对年率差异为每患者年 1.69 个住院天数（95% CI，0.45 至 2.93）。同样，在倾向匹配模型中，关闭与住院率高出 7% 相关（RR，1.07；95% CI，1.00 至 1.13；P =0.04），产生每年 1.08 住院天数的绝对率差异（95 % 置信区间，0.04 至 2.12）。关闭与死亡率的非显着增加相关（风险比 [HR]，1.08；95% CI，1.00 至 1.18；P=0.05 用于设施匹配比较；心率，1.08；95% 置信区间，0.99 至 1.17；对于倾向匹配比较，P = 0.08）。

受透析设施关闭影响的患者在随后的 180 天内住院率增加，死亡风险可能增加。这突出表明需要有效的政策来继续降低设施关闭的风险。