Experiences of Care Among Medicare Beneficiaries With ESRD:
Medicare Consumer Assessment of Healthcare Providers and
Systems (CAHPS) Survey Results
Charlotte A.M. Paddison, PhD,1Marc N. Elliott, PhD,2Amelia M. Haviland, PhD,3,4
Donna O. Farley, PhD,3Georgios Lyratzopoulos, MD,1Katrin Hambarsoomian, MS,2
Jacob W. Dembosky, MPM,3and Martin O. Roland, DM1
Background: Patients with end-stage renal disease (ESRD) have special health needs; little is known about
their care experiences.
Study Design: Secondary analysis of 2009-2010 Medicare Consumer Assessment of Healthcare Providers
and Systems (CAHPS) data, using representative random samples of Medicare beneficiaries. Description of
Medicare beneficiaries with ESRD and investigation of differences in patient experiences by sociodemographic
characteristics and coverage type.
Setting & Participants: Data were collected from 823,564 Medicare beneficiaries (3,794 with ESRD) as
part of the Medicare CAHPS survey, administered by mail with telephone follow-up of nonrespondents.
Predictor: ESRD status, age, education, self-reported general and mental health status, race/ethnicity, sex,
Medicare coverage type, state of residence, and other demographic measures.
Outcomes: 6 composite measures of patient experience in 4 care domains (access to care, physician
communication, customer service, and access to prescription drugs and drug information) and 4 ratings
(overall care, personal physician, specialist physician, and prescription drug plan).
Results: Patients with ESRD reported better care experiences than non-ESRD beneficiaries for 7 of 10
measures (P ? 0.05) after adjustment for patient characteristics, geography, and coverage type, although to
only a small extent (adjusted mean difference, ?3 points [scale, 0-100]). Black patients with ESRD and less
educated patients were more likely than other patients with ESRD to report poor experiences.
Limitations: Inability to distinguish patient experiences of care for different treatment modalities.
Conclusions: On average, beneficiaries with ESRD report patient experiences that are at least as positive
as non-ESRD beneficiaries. However, black and less educated patients with ESRD reported worse experi-
ences than other ESRD patients. Stratified reporting of patient experience by race/ethnicity or education in
patients with ESRD can be used to monitor this disparity. Physician choice and confidence and trust in
physicians may be particularly important for patients with ESRD.
Am J Kidney Dis. xx(x):xxx. © 2012 by the National Kidney Foundation, Inc. Published by Elsevier Inc. All rights
INDEX WORDS: End-stage renal disease; patient experience; race/ethnicity; Medicare; Consumer Assess-
ment of Healthcare Providers and Systems (CAHPS).
typically require dialysis or kidney transplantation. In
the United States, they are eligible for Medicare cover-
age regardless of age if they have worked the required
amount of time under Social Security.1There has been
little previous research describing the care experi-
ences of Medicare beneficiaries with this serious
Providing good quality of care for people with
ESRD is challenging given the cost and complexity of
treatment. Quality is understood best as a multidimen-
sional construct2-4informed by evidence of clinical
effectiveness, patient safety, and patient experiences.
Information for patient experiences, as measured by
the Consumer Assessment of Healthcare Providers
and Systems (CAHPS) family of surveys and other
instruments, can be used to drive improvements in
quality of care,5,6and as such, forms a useful comple-
ment to assessments of clinical quality.
eople with end-stage renal disease (ESRD) have
complete or nearly complete kidney failure and
Pay-for-performance schemes are being used in-
creasingly to incentivize improvements in health care
quality. Under the Patient Protection and Affordable
Care Act (2010), patient experience scores will affect
quality bonuses received by Medicare Advantage
plans. These scores are derived from the Medicare
From the1Cambridge Centre for Health Services Research,
Institute of Public Health, University of Cambridge, Forvie Site,
CA;3RAND Corporation; and4Heinz College, Carnegie Mellon
University, Pittsburgh, PA.
Received April 12, 2012. Accepted in revised form October 6,
Address correspondence to Marc N. Elliott, PhD, RAND Corpo-
ration, 1776 Main St, Santa Monica, CA 90401-3208. E-mail:
Am J Kidney Dis. 2012;xx(x):xxx1
CAHPS survey, annually administered by the Centers
for Medicare & Medicaid Services (CMS) to a nation-
ally representative sample of Medicare beneficiaries,
and will have financial implications for US providers.
In contrast to the extensive research examining the
clinical quality of care provided to patients with
ESRD (eg,7,8), there is relatively little research exam-
ining patient-reported experiences in patients with
ESRD, most of it based on the US Renal Data System
The aim of this research is to describe Medicare
beneficiaries with ESRD (representing ?78% of all
571,414 US individuals with ESRD in 20099-11) and
their care experiences, including self-reported charac-
teristics and experiences that otherwise are not avail-
ences in patient experiences between Medicare
beneficiaries with and without ESRD, and in those
with ESRD, to examine variation in patient experi-
ences reported by sociodemographic group and cover-
Data were collected as part of the Medicare CAHPS survey,12
which assesses patients’ health care experiences in a representative
random sample of ?1.5% of the approximately 47 million Medi-
care beneficiaries and is a mail survey with telephone follow-up of
nonrespondents. We used pooled data from the 2009-2010 Medi-
care CAHPS surveys of MedicareAdvantage beneficiaries and for
fee-for-service (FFS) beneficiaries, with and without a free-
standing prescription drug plan. Surveys from 823,564 beneficia-
ries were analyzed (FFS, 327,246; MedicareAdvantage, 496,318),
including 3,794 (0.5%) with ESRD (these respondents represent
?1% of all Medicare beneficiaries with ESRD). The overall
response rates were 50.8% for beneficiaries with ESRD and 60.9%
Ten measures of patients’ health care constitute the primary
outcomes of interest: 4 global ratings of care and 6 composite
measures. All Medicare CAHPS measures were linearly rescaled
to a possible range of 0-100 for comparability and ease of interpre-
tation, so that the transformed score y ? 100 ? (x-a)/(b-a), where
the original score x was on a scale from a to b.
The 4 global items were rated on a scale from 0 (worst possible
care) to 10 (best possible care). Patients were asked to rate the
health care they had received in the last 6 months. Additionally,
patients with personal physicians, Medicare prescription drug
their personal physician, prescription drug plan, or specialist,
respectively. Many patients with ESRD may consider their neph-
rologist to be their personal physician as opposed to a specialist
because ?20% may have a family physician, and nephrologists
with ESRD for primary care.13-17
Six composite scores measured patient experiences in 4 care
domains: access, physician communication, customer services,
and prescription plan. All responses were given on a Likert scale
ite is the sum of its transformed constituent items.18Further detail
for the 6 composite measures can be found in Item S1 (provided as
online supplementary material).
The following data were obtained from the Medicare CAHPS
survey (see first table): sex, race/ethnicity, age, education, self-
rated overall and mental health status, and proxy status. The
following information was obtained from CMS administrative
files: ESRD status, beneficiary’s coverage type (including Medi-
care Advantage and Special Needs Plans [for beneficiaries with
certain chronic conditions or who are dually eligible for Medicare
and Medicaid] in particular), and a low income subsidy indicator
(income ?150% of the federal poverty line). It was not possible to
obtain data for ESRD treatment modality (eg, whether a patient
had non–dialysis-dependent chronic kidney disease, was receiving
peritoneal dialysis or hemodialysis, or was posttransplantation) or
care setting (eg, large or small hospital or clinic or patient’s own
To assess the generalizability of the ESRD Medicare CAHPS
sample, we compared it to the distribution of characteristics of the
USRDS ESRD patient population. Since 1988, in a joint effort
with the CMS and the National Institute of Diabetes and Digestive
and Kidney Diseases, the USRDS annually collects data for the
ESRD patient population and publishes their findings in the
Annual Data Report. We report on USRDS data from 2009, which
became available as of the 2011 USRDSAnnual Data Report.19
To compare demographic characteristics of patients with ESRD
with those of other Medicare beneficiaries, a series of bivariate
logistic regression models predicted ESRD status (present or
absent) from each of the demographic case-mix adjustors. Stan-
dard case-mix Medicare CAHPS adjustment variables include age,
education level, general and mental health status, low income
subsidy, and proxy status.18We additionally evaluated the associa-
tion of ESRD status with sex, race/ethnicity, and enrollment in
Medicare Advantage and Special Needs plans. For reference, a
3-point increase in some CAHPS measures on a 0-100 scale has
been associated with a 30% reduction in disenrollment from plans;
thus, one might consider differences of this magnitude to be
Next, we compared the experiences of patients with ESRD with
those of patients without ESRD, adjusting for patient characteris-
tics to control for demographic differences between the 2 groups.
First, for each of the 10 outcome measures separately, a mixed-
effects linear regression model was estimated, with ESRD status,
survey year, and each of the case-mix adjustors as independent
variables (fixed effects). Random effects for state of residence and
Medicare Advantage contract (treating FFS as an additional con-
tract) controlled for location and health plan. We then estimated a
second series of identical models restricted to ESRD beneficiaries
to compare the experiences of patients with ESRD with different
We repeated the mentioned analyses in 3 ways as sensitivity
analyses: (1) substituting patients who had been told by a physi-
Am J Kidney Dis. 2012;xx(x):xxx2
Paddison et al
cian that they had diabetes for patients with ESRD (to assess the
patients with other chronic conditions), (2) restricting to ages 65
years and older (because Medicare eligibility for younger than 65
years is restricted to the disabled), and (3) using 1-to-1 matching of
ESRD to non-ESRD patients (using the full set of covariates
Plan-level weights accounting for survey design and nonre-
sponse were used in all analyses, performed in SAS, version 9.2
(SAS Institute Inc), which corrected for the design effects of these
weights using the linearization method implemented by SAS
Table 1 lists demographic characteristics and self-
reported health for Medicare beneficiaries with and
without ESRD, which are consistent with expecta-
tions. (See Item S2 for characteristics of USRDS
tially smaller proportion of women (44% vs 56%),
tage beneficiaries (12% vs 23%) in comparison to
respondents without ESRD.
Beneficiaries with ESRD were much more likely to
be younger than 65 years (49% vs 15% of other
beneficiaries), as might be expected from eligibility
criteria that generally restrict Medicare coverage to
those 65 years and older, but provide coverage for
people meeting entitlement definitions for ESRD or
disability regardless of age. Beneficiaries with ESRD
were more likely to receive a low income subsidy
(44% vs 20% of others).
Beneficiaries with ESRD tended to have much
worse self-rated general health status. Almost two-
thirds of those with ESRD (64%) reported fair or poor
health status compared with only 32% of those with-
Similarly, 43% of USRDS patients are women. The
USRDS patient population is more likely to be white
(61%) and younger than 65 years (63%) than the
Medicare CAHPS ESRD population.
Adjusted analyses in Table 2 compare patient expe-
riences of Medicare beneficiaries with ESRD with
those of other beneficiaries with similar case-mix
characteristics, in similar areas, and with similar cov-
erage type. A positive estimate of the adjusted mean
difference in patient experiences of care (Medicare
CAHPS score) indicates better experiences of care for
those with ESRD than their non-ESRD counterparts.
We observed better experiences for patients with
ESRD for rating of care (0.68 point on the 0-100
scale; P ? 0.01), rating of physician (0.77 point; P ?
0.001), rating of prescription drug plan (0.98 point;
P ? 0.002), getting prescription drugs (0.86 point; P ?
0.01), getting needed care (1.05 points; P ? 0.001),
customer service (2.74 points; P ? 0.001), and getting
care quickly (2.39 points; P ? 0.001). These results
show that beneficiaries with ESRD reported better
experiences than their non-ESRD counterparts for 7
of 10 measures, although the magnitude of these
differences between ESRD and non-ESRD beneficia-
ries is small (?3 points difference on a scale of
0-100). Beneficiaries with ESRD did not have poorer
experiences of care than non-ESRD beneficiaries on
any of the 10 experience measures considered here.
Table 3 lists adjusted mean values from the second
series of mixed-effects regressions including only
patients with ESRD and shows differences in patient
experiences of care by sociodemographics, self-rated
health, and coverage type within the ESRD group.
The most notable differences relate to race/ethnicity
and education. Black patients with ESRD reported
worse experiences versus white patients with ESRD
on rating of care (79.2 vs 81.6 points; difference,
?2.4; P ? 0.007), rating of physician (87.1 vs 88.7
points; difference, ?1.6; P ? 0.03), rating of special-
ist (84.6 vs 86.9 points; difference, ?2.4; P ? 0.02),
rating of prescription drug plan (79.8 vs 81.8 points;
difference, ?2.0; P ? 0.04), getting prescription
drugs (83.6 vs 86.3 points; difference, ?2.7; P ?
0.008), and physician communication (86.5 vs 89.0
points; difference, ?2.6; P ? 0.002). Patients with
ESRD who did not attend high school reported worse
experiences versus high school graduates on rating of
care (77.1 vs 81.9 points; difference, ?4.7; P ?
0.001), getting needed care (77.2 vs 85.3 points;
difference, ?8.1; P ? 0.001), and physician commu-
nication (85.5 vs 89.8 points; difference, ?4.3; P ?
Analysis of mean differences for the 3 physician
measures show that on average, black patients with
ESRD reported less positive experiences with physi-
cians than white patients (mean difference for rating
of physician, 1.6 points; for ratings of specialist, 2.4
points; and for physician communication, 2.6 points),
although the magnitude of these differences is modest
(?3 points on a 0-100 scale). Black patients with
ESRD also reported more difficulty getting needed
prescription drugs than white patients with ESRD
(mean difference, 2.7 points). Differences between
patients with ESRD who had not attended high school
and high school graduates are somewhat larger, rang-
ing from 4.3-8.1 points (the latter for getting needed
care). There are some differences in the experience of
patients with ESRD by self-reported health, with
Am J Kidney Dis. 2012;xx(x):xxx3
ESRD Patient Experience
Table 1. Demographic Characteristics and Health of Medicare Beneficiaries With and Without ESRD, 2009-2010
ESRD No ESRDPb
ESRD No ESRD
Total (N ? 823,564)
Special Needs Plans
Some high school but no diploma
High school diploma
Some college, but no 4-y degree
4-y college degree only
?4-y college degree
Self-rated general health status
Self-rated mental health status
Assistance from proxy
Received low-income subsidy statusd
Note: Data are from 2009-2010 (N ? 823,564).
Abbreviation: ESRD, end-stage renal disease.
aIndividual-level weights were used to calculate weighted percentages.
bP values correspond to logistic regressions predicting each nonimputed case-mix or characteristic indicator from an ESRD indicator.
cBeneficiaries with ESRD are shown to be younger (?65 years; 49%) than non-ESRD beneficiaries (?65 years; 15%), and this likely is a consequence
of Medicare eligibility criteria that generally restrict coverage to those 65 years and older, but provide coverage for all people with ESRD or legal disability
regardless of age.
dIncome ?150% of federal poverty line.
Am J Kidney Dis. 2012;xx(x):xxx4
Paddison et al
those in better health typically having reported better
experiences. Table 3 shows little evidence of differ-
ences in the experience of patients with ESRD by age,
sex, or coverage type.
Table a of Item S3 shows that patients with diabetes
generally have slightly more positive experiences
than those without diabetes (5 positive and 1 negative
difference were statistically significant; all differences
were ?1 point), smaller differences than were seen
for patients with ESRD. As is the case for ESRD,
patients with diabetes who are black and those with-
out a high school degree reported generally worse
experiences than other patients with diabetes (Table b
of Item S3). As seen in Tables c and d of Item S3,
findings are similar when we restrict to patients 65
years and older. Finally, matching ESRD with non-
ESRD patients produces results similar to those re-
In this study, we find that Medicare beneficiaries
with ESRD (N ? 3,794) report patient experiences,
Medicare beneficiaries without ESRD. We find that
these Medicare patients are similar to the USRDS
care ESRD sample is less likely to be white and is
more likely to be older than 65 years.
with other beneficiaries with similar case-mix charac-
teristics, in similar areas, and with similar coverage
type, we find that patients with ESRD reported some-
what more positive experiences of care. Although the
magnitude of effect was small, it was directionally
consistent and was observed for 7 of the 10 measures.
There are a number of possible explanations for this
finding. We outline 2 possibilities: differences in ex-
pectations and the role of chronic conditions more
generally. First, beneficiaries with and without ESRD
may have different expectations resulting from pre-
Medicare health care and health insurance experi-
ences. Beneficiaries with ESRD are especially likely
to have low educational attainment.As such, a dispro-
portionate number may have had limited health insur-
ance prior to kidney failure making them eligible for
Medicare by classifying them as patients with ESRD.
Thus, Medicare coverage may represent a dramatic
improvement in coverage and care for some ESRD
beneficiaries. However, findings that in patients with
ESRD, the least educated had the worst Medicare
experiences, may cast doubt on this explanation.
Second, the positive experiences of care in Medi-
care beneficiaries with ESRD may reflect in part a
general pattern in patients with life-threatening non-
acute illnesses (eg, patients with cancer) to report high
satisfaction and better patient experiences than pa-
tients without such conditions.23Frequent contact
with the same providers over a prolonged period may
contribute to the positive experiences reported by
ESRD beneficiaries. For example, many patients re-
ceiving dialysis in hospital-based outpatient centers
meet with their nephrology team 3 or more times
weekly; similarly, care after kidney transplantation
involves frequent follow-up care interactions with the
patients’ nephrology team. Nephrologists also have a
Table 2. Differences in Patient Experiences in Medicare Beneficiaries With and Without ESRD, 2009-2010
ESRD Non-ESRD Difference (95% CI)P
Rating of care
Rating of physician
Rating of specialist
Rating of PDP
Getting prescription drugs
Getting information for drugs
Getting needed care
Getting care quickly
0.68 (0.15 to 1.21)
0.77 (0.29 to 1.24)
0.09 (?0.48 to 0.66)
0.98 (0.36 to 1.61)
0.86 (0.21 to 1.51)
0.13 (?1.26 to 1.52)
1.05 (0.41 to 1.69)
2.74 (1.51 to 3.96)
2.39 (1.68 to 3.09)
0.24 (?0.29 to 0.76)
Note: Patient experiences quantified as adjusted mean Medicare CAHPS scores. Results for ESRD indicator from linear regression
model that includes fixed effects for sex, race/ethnicity (black, Hispanic, and white plus all others), indicator for 2010 survey year, and
standard Medicare CAHPS case-mix adjustors (age, education, general health status, mental health status, low income supplement,
and proxy assistance). Models include random effects for state and Medicare Advantage contract. Medicare CAHPS measures are
linearly rescaled to 0-100. Higher scores correspond to better patient experience.
Abbreviations: CAHPS, Consumer Assessment of Healthcare Providers and Systems; CI, confidence interval; ESRD, end-stage
renal disease; PDP, prescription drug plan.
Am J Kidney Dis. 2012;xx(x):xxx5
ESRD Patient Experience
Table 3. Patient Experiences of Care by Sociodemographic Group in Medicare Beneficiaries With ESRD
Race/Ethnicity Age (y)EducationSelf-rated Health SexCoverage Type
Rating of care
Rating of physician
Rating of specialist
Rating of PDP
Getting prescription drugs
Getting information for drugs
Getting needed care
Getting care quickly
Am J Kidney Dis. 2012;xx(x):xxx
Paddison et al
including preventative general medical care, care for
minor acute illnesses, and care for comorbid condi-
tions (diabetes mellitus, cardiac disease, and gastroin-
testinal disease).16This explanation is supported in
part by a similar but weaker finding of more positive
experiences in patients with diabetes than those with-
out diabetes, given that diabetes is a chronic condition
with somewhat less intense contact with the health
We found that black ESRD beneficiaries were more
likely than white beneficiaries to report poor patient
experiences, a pattern that may be particular to condi-
tions such as ESRD because it does not hold consis-
tently for blacks compared with whites for the Medi-
care population as a whole.24Previous research
suggests racial/ethnic disparities also exist in renal
replacement therapy, including differences in referral
and initiation of dialysis therapy, adequacy of dialy-
sis, and anemia management.25,26There is evidence
that racial disparities persist for important clinical
outcomes, even within integrated delivery systems
such as the VeteransAdministration.27
In particular, we noted that black beneficiaries
reported less positive experiences with physicians
(both personal physicians and specialists). These dif-
ferences may reflect worse access to care and lower
clinical quality of care for black patients with ESRD
compared with white patients with ESRD.28-34In
addition, previous literature35-37suggests that confi-
dence in one’s physician is a salient issue for black
patients, and that black patients in general often may
express a preference for black physicians. Poorer
reported experiences for black patients with ESRD
may reflect difficulty locating a desired ethnically
concordant specialist nearby, a possibility than could
be examined in further research. Relatedly, there may
be differences by patient race/ethnicity in ease of
obtaining referrals to a specialist.38,39
Finding a policy strategy to address the discrepan-
cies between black and nonblack patients’ care expe-
riences is a difficult issue, in part because of the
As noted by others, improving cross-cultural patient-
physician communication and facilitating access to a
diverse group of physicians may increase patient
involvement in care and satisfaction and improve
outcomes.40Adapting this principle to the ESRD
population could involve nephrologists, dialysis clin-
ics, and larger aspects of the health care system. One
key action would be implementation of regular report-
ing of differences in patient experiences of care by
race/ethnicity in Medicare beneficiaries with ESRD.
Such reporting has been advocated previously41and
now is required at the health plan level by the Medi-
Table 3 (Cont’d). Patient Experiences of Care by Sociodemographic Group in Medicare Beneficiaries With ESRD
Note: Data show adjusted mean values of Medicaare CAHPS scores from mixed-effects models applied to ESRD group only.
Abbreviations: CAHPS, Consumer Assessment of Healthcare Providers and Systems; ESRD, end-stage renal disease; F, female; FFS, fee-for-service; GED, General Education Development certificate; grad,
graduate; HS, high school; M, male; MA, Medicare Advantage; PDP, prescription drug plan.
Am J Kidney Dis. 2012;xx(x):xxx7
ESRD Patient Experience
care Improvements for Patients and Providers Act of
In addition, the least educated ESRD beneficiaries
reported poorer physician communication and care,
also a pattern that may be particular to ESRD and
other chronic conditions and may reflect the complex-
ity of ESRD care. Although it also holds for patients
with diabetes, it does not hold consistently for the
literacy is most common in those with low educa-
tional attainment,43this finding may point to the need
to improve health literacy in ESRD beneficiaries and
make the process of care and physician interactions
more accommodating of patients with ESRD with low
Consistent with previous studies of non-ESRD pa-
tient populations,44,45we found that ESRD beneficia-
ries in better self-reported health are more likely to
report positive experiences of care. Previous research
also has indicated some differences in patient-
reported experiences of care by coverage type.
Ratings of physicians tend to be higher in FFS than
Medicare Advantage in general, perhaps because of
the greater ability to see a physician of one’s
choosing in FFS, whereas prescription drug and
customer service typically are more positive in Medi-
beneficiaries in this study, we found no consistent
tendency for more positive experiences in Medicare
Advantage or FFS, perhaps reflecting that provisions
for the care of patients with ESRD are relatively
uniform and independent of coverage type.
Strengths of this study include data from a large
nationally representative survey of patient experi-
ences (Medicare CAHPS), which enable us to de-
scribe the characteristics of Medicare beneficiaries
with ESRD and their experiences of care and also to
compare Medicare beneficiaries with and without
ESRD. Although response rates were 51% for ESRD
and 61% for non-ESRD beneficiaries, recent analyses
of these and other CAHPS data have not found
evidence of nonresponse bias when case-mix adjust-
ment is used.44,48
There also are some limitations. The Medicare
ESRD beneficiary group is not perfectly representa-
tive of the USRDS patient population: in particular,
the ESRD beneficiary group is older and more likely
to be white than all USRDS patients. Despite being
one of the largest surveys of ESRD patients’ experi-
ences (N ? 3,794), the study may still have been
underpowered to detect small between-group differ-
ences within the ESRD beneficiary group. We were
unable to obtain data to distinguish between patient
experiences for subgroups of ESRD patients’ differ-
ent treatment (eg, patients with advanced kidney dis-
ease who were not yet receiving renal replacement
dialysis, and patients with a functioning kidney trans-
plant) or between patients treated in different settings
(eg, home, small regional hospital, or large teaching
hospital). It is possible that there is sociodemographic
variation in the experience of patients with ESRD
treated by different modalities or in different settings.
Finally, patients with ESRD have less access to Medi-
careAdvantage plans than non-ESRD patients; only a
other Medicare beneficiaries may choose from a large
number of general MedicareAdvantage plans. Further
research is needed to distinguish among several com-
peting explanations for this study’s results; the CMS-
sponsored In-Center Hemodialysis CAHPS Survey,
which began implementation as of late 2012, may
provide such an opportunity.
In conclusion, it is encouraging to learn from our
study that on average, beneficiaries with ESRD report
patient experiences at least comparable with non-
ESRD beneficiaries. However, we also found some
evidence of sociodemographic differences in patient
care experiences, with black and less educated ESRD
Medicare beneficiaries reporting poorer experiences
of care than other beneficiaries with ESRD. Educa-
tional outreach, efforts targeting physician supply and
patient choice, and measurement of patient experi-
ences according to sociodemographic subgroups may
reduce these differences.
The authors thank Aneetha Ramadas, AB, and Daisy Montfort,
AB, of the RAND Corporation for assistance with manuscript
preparation as part of compensated employment and Roberto
Vargas, MD, for comments on an earlier version of this manu-
Support: This study was funded by CMS contract HHSM-500-
2005-00028I to RAND Corporation. Dr Elliott and Dr Farley were
supported in part by a cooperative agreement from theAgency for
Healthcare Research and Quality U18 HS016980.
Financial Disclosure: The authors declare that they have no
other relevant financial interests.
Item S1. Detail on 6 composite measures assessing patient
experiences in 4 specific domains of care.
Item S2. Treatment modalities and characteristics of USRDS
Item S3. Additional analyses for diabetic subgroups and benefi-
ciaries 65 years and older.
Note: The supplementary material accompanying this article
(http://dx.doi.org/10.1053/j.ajkd.2012.10.009) is available at
Am J Kidney Dis. 2012;xx(x):xxx8
Paddison et al
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