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Medicare provides near-universal coverage for end-stage renal disease (ESRD), so assessing the wide regional variations in cost and quality of care is important. Researchers used data from a national registry to categorize more than 41,000 patients (age, ≥65) with incident ESRD (initiation of dialysis or renal transplant) according to the overall cost and intensity of care provided in each patient's hospital referral region (HRR) in the last 6 months of life.
HRRs in the highest-cost quintile had a greater concentration of nephrologists than did those in the lowest quintile, yet ESRD patients in the highest-cost HRRs were less likely to have received care from nephrologists before developing ESRD (62% vs. 71%). Patients in the highest-cost H…