Janet Lynch - Academia.edu (original) (raw)

Papers by Janet Lynch

Background: Interventions to improve maturation or prolong the function of HD access are common. ... more Background: Interventions to improve maturation or prolong the function of HD access are common. Interventional radiologists (IR) have traditionally done these services in hospitals. Recently, internists/interventional nephrologists (IN) and access surgeons (AS) have begun to perform these access salvage procedures. The extent of this shift in practice is not well documented. Methods: We reviewed CY 2009 claims submitted to the Centers for Medicare & Medicaid Services (CMS) for dialysis-related access procedures done in NW5. We grouped practitioners by self-designated CMS specialty codes: AS (gen surg 2, thorac surg 33, vasc surg 76+77), IN (int med 11, nephrology 39) and IR (diagnostic radiol 30, interventional radiol 94). We grouped procedures by CPT code: fistulography (36145), percutaneous (precut) interventions (angioplasty 35476, G0392, G0393; and percut thrombectomy 36870), tunneled catheter (HD cath) placement (36558), HD cath exchange (36581), AVF or AVG construction (36818...

American Journal of Kidney Diseases

Background: Lok et al previously reported a risk equation for arteriovenous fistula (AVF) maturat... more Background: Lok et al previously reported a risk equation for arteriovenous fistula (AVF) maturation failure. It is unclear whether this model or a more comprehensive model correlates with incident AVF use in the US hemodialysis population. Study Design: Cross-sectional study. Setting & Participants: 195,756 adult patients initiating outpatient hemodialysis therapy in the United States between July 1, 2005, and December 31, 2009, with 6 months or more prior nephrology care. Predictor: Patient characteristics (age, peripheral vascular disease, coronary artery disease, and race) populating the AVF maturation failure risk equation and other demographic and clinical variables from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report (CMS 2728). Outcomes & Measurements: AVF use at first outpatient dialysis treatment as recorded on the CMS 2728. Results: Using the risk categories defined by Lok et al, AVF use varied from 19.0% (very high risk) to 25.6% (low risk). In...

British Journal of Haematology, 2012

Adequate pre-dialysis care reduces mortality among end-stage renal disease (ESRD) patients. We te... more Adequate pre-dialysis care reduces mortality among end-stage renal disease (ESRD) patients. We tested the hypothesis that individuals with ESRD due to sickle cell disease (SCD-ESRD) receiving pre-ESRD care have lower mortality compared to individuals without pre-ESRD care. We examined the association between mortality and pre-ESRD care in incident SCD-ESRD patients who started haemodialysis between 1 June, 2005 and 31 May, 2009 using data provided by the Centers for Medicare and Medicaid Services (CMS). SCD-ESRD was reported for 410 (0Á1%) of 442 017 patients. One year after starting dialysis, 108 (26Á3%) patients with incident ESRD attributed to SCD died; the hazard ratio (HR) for mortality among patients with SCD-ESRD compared to those without SCD as the primary cause of renal failure was 2Á80 (95% confidence interval [CI] 2Á31-3Á38). Patients with SCD-ESRD receiving pre-dialysis nephrology care had a lower death rate than those with SCD-ESRD who did not receive predialysis nephrology care (HR = 0Á67, 95% CI 0Á45-0Á99). The one-year mortality rate following an ESRD diagnosis was almost three times higher in individuals with SCD when compared to those without SCD but with ESRD and could be attenuated by pre-dialysis nephrology care.

American Journal of Kidney Diseases, 2011

Background-The Centers for Medicare & Medicaid Services (CMS) established a national goal of 66% ... more Background-The Centers for Medicare & Medicaid Services (CMS) established a national goal of 66% arterio-venous fistula (AVF) use among prevalent hemodialysis (HD) patients for the current Fistula First Breakthrough Initiative (FFBI). The feasibility of achieving the goal has been debated. We examined contemporary patterns of AVF use among prevalent patients to assess the potential for attaining the goal by dialysis facilities and their associated end-stage renal disease (ESRD) Networks in the United States (US).

American Journal of Kidney Diseases, 2012

American Journal of Kidney Diseases, 2012

Current Opinion in Nephrology and Hypertension, 2011

This review summarizes the background and implementation of the Fistula First Breakthrough Initia... more This review summarizes the background and implementation of the Fistula First Breakthrough Initiative (FFBI), published information about changes in vascular access practice since its inception, and several issues raised by the program.

Background: Interventions to improve maturation or prolong the function of HD access are common. ... more Background: Interventions to improve maturation or prolong the function of HD access are common. Interventional radiologists (IR) have traditionally done these services in hospitals. Recently, internists/interventional nephrologists (IN) and access surgeons (AS) have begun to perform these access salvage procedures. The extent of this shift in practice is not well documented. Methods: We reviewed CY 2009 claims submitted to the Centers for Medicare & Medicaid Services (CMS) for dialysis-related access procedures done in NW5. We grouped practitioners by self-designated CMS specialty codes: AS (gen surg 2, thorac surg 33, vasc surg 76+77), IN (int med 11, nephrology 39) and IR (diagnostic radiol 30, interventional radiol 94). We grouped procedures by CPT code: fistulography (36145), percutaneous (precut) interventions (angioplasty 35476, G0392, G0393; and percut thrombectomy 36870), tunneled catheter (HD cath) placement (36558), HD cath exchange (36581), AVF or AVG construction (36818...

American Journal of Kidney Diseases

Background: Lok et al previously reported a risk equation for arteriovenous fistula (AVF) maturat... more Background: Lok et al previously reported a risk equation for arteriovenous fistula (AVF) maturation failure. It is unclear whether this model or a more comprehensive model correlates with incident AVF use in the US hemodialysis population. Study Design: Cross-sectional study. Setting & Participants: 195,756 adult patients initiating outpatient hemodialysis therapy in the United States between July 1, 2005, and December 31, 2009, with 6 months or more prior nephrology care. Predictor: Patient characteristics (age, peripheral vascular disease, coronary artery disease, and race) populating the AVF maturation failure risk equation and other demographic and clinical variables from the Centers for Medicare & Medicaid Services (CMS) Medical Evidence Report (CMS 2728). Outcomes & Measurements: AVF use at first outpatient dialysis treatment as recorded on the CMS 2728. Results: Using the risk categories defined by Lok et al, AVF use varied from 19.0% (very high risk) to 25.6% (low risk). In...

British Journal of Haematology, 2012

Adequate pre-dialysis care reduces mortality among end-stage renal disease (ESRD) patients. We te... more Adequate pre-dialysis care reduces mortality among end-stage renal disease (ESRD) patients. We tested the hypothesis that individuals with ESRD due to sickle cell disease (SCD-ESRD) receiving pre-ESRD care have lower mortality compared to individuals without pre-ESRD care. We examined the association between mortality and pre-ESRD care in incident SCD-ESRD patients who started haemodialysis between 1 June, 2005 and 31 May, 2009 using data provided by the Centers for Medicare and Medicaid Services (CMS). SCD-ESRD was reported for 410 (0Á1%) of 442 017 patients. One year after starting dialysis, 108 (26Á3%) patients with incident ESRD attributed to SCD died; the hazard ratio (HR) for mortality among patients with SCD-ESRD compared to those without SCD as the primary cause of renal failure was 2Á80 (95% confidence interval [CI] 2Á31-3Á38). Patients with SCD-ESRD receiving pre-dialysis nephrology care had a lower death rate than those with SCD-ESRD who did not receive predialysis nephrology care (HR = 0Á67, 95% CI 0Á45-0Á99). The one-year mortality rate following an ESRD diagnosis was almost three times higher in individuals with SCD when compared to those without SCD but with ESRD and could be attenuated by pre-dialysis nephrology care.

American Journal of Kidney Diseases, 2011

Background-The Centers for Medicare & Medicaid Services (CMS) established a national goal of 66% ... more Background-The Centers for Medicare & Medicaid Services (CMS) established a national goal of 66% arterio-venous fistula (AVF) use among prevalent hemodialysis (HD) patients for the current Fistula First Breakthrough Initiative (FFBI). The feasibility of achieving the goal has been debated. We examined contemporary patterns of AVF use among prevalent patients to assess the potential for attaining the goal by dialysis facilities and their associated end-stage renal disease (ESRD) Networks in the United States (US).

American Journal of Kidney Diseases, 2012

American Journal of Kidney Diseases, 2012

Current Opinion in Nephrology and Hypertension, 2011

This review summarizes the background and implementation of the Fistula First Breakthrough Initia... more This review summarizes the background and implementation of the Fistula First Breakthrough Initiative (FFBI), published information about changes in vascular access practice since its inception, and several issues raised by the program.