Date of Conferral

2022

Degree

Ph.D.

School

Health Services

Advisor

Michael Furukawa

Abstract

Home dialysis is a cost-effective and efficient means of treating end-stage renal disease. Under-utilization of home dialysis results in higher than necessary Medicare spending and loss of quality of life for patients. The purpose of this study was to understand the relationship between a nephrologist's length of time in practice, a nephrologist's belonging to a Joint Venture (JV) financial arrangement with a home modality program, and the use of home dialysis and home modality education using a quantitative, correlational design. Roger's diffusion of innovation theory explains the varying willingness of individuals to accept innovation. Secondary data were collected from Medicare and the Illinois Department of Health. Nephrologists were identified for inclusion based on having a specialty of nephrology, having billed for the HCPCS codes 90951-90970 in the year 2018, and having an address in the state of Illinois. Multiple linear regression analysis calculations run using SPSS determined a statistically significant relationship of .341, with a physician belonging to a JV practice accounting for 11.6% of the variance in home dialysis usage, length of time in practice did not have a statistically significant effect. Data were not available to analyze if a relationship between nephrologist characteristics and home modality education existed. Understanding the relationship between nephrologist characteristics and home dialysis usage provides the opportunity for improved nephrologist relationships regarding JV practices. Additionally, it may provide new insight for the construction of programs to target a home-first dialysis initiative, supporting the country's Advancing American Kidney Health initiative supporting positive social change.

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