Availability and quality of dialysis care in rural versus urban U.S. counties.

INTRODUCTION: Rural areas face significant disparities in dialysis care compared to urban areas due to limited access to dialysis facilities, longer travel distances, and a shortage of healthcare professionals. The objective of this study is to conduct a national examination of rural-urban differences in quality of dialysis care offered across counties in the U.S.

METHODS: Data was gathered from Medicare-certified dialysis facilities in 2020 from the Centers for Medicare & Medicaid Services website. To identify high-need counties, county-level estimated crude prevalence of diabetes in adults were obtained from the 2022 CDC PLACES data portal. Our analysis reviewed 3,141 counties in the U.S. The primary outcome measured was whether the county had a dialysis facility. Among those counties that had a dialysis facility, additional outcomes were the average star rating, whether peritoneal dialysis was offered, and whether home dialysis was offered.

RESULTS: Type of services offered by dialysis facilities varied significantly, with peritoneal dialysis the most commonly offered services (50.8%), followed by home hemodialysis (28.5%), and late shift services (16.0%). These service availabilities are more prevalent in urban facilities than in rural facilities. The Centers for Medicare & Medicaid Services Five Star Quality ratings were quite different between urban and rural facilities, with 40.4% of rural facilities having a ranking of five, compared to 27.1% in urban.

CONCLUSION: The majority of rural counites lack a single dialysis facility. Counties with high rates of chronic kidney disease, diabetes, and blood pressure, deemed high need, were less likely to have a highly rated dialysis facility. The findings can be used to further inform targeted efforts to increase diabetes educational programming and design appropriate interventions to those residing in rural communities and high need counties who may need it the most.