Examining Disparities in Quality of Dialysis Facilities in Puerto Rico vs. Five Mainland US States Before and After Hurricane Maria (2015-2023)

Beheshtian, Kiana

Full Metadata

Overview

Year:: 2024
Contributor:: Beheshtian, Kiana (creator); Rivera-Hernandez, Maricruz (Advisor); Dosa, David (Reader); Brown University. School of Public Health (sponsor)
Genre:: theses
Subject:: Public health; Quality Improvement; Chronic renal failure; health policy; Disasters--Management; Puerto Rico
Extent:: i-iv., 15 p.

Files

Description

Abstract:: Introduction: Individuals living in Puerto Rico experience a multitude of challenges, including poverty, inadequate infrastructure, a fragile healthcare system, and an increased vulnerability to climate change-related disasters. In 2017, Hurricanes Irma and Maria devastated the island. Individuals with non-communicable diseases, such as chronic kidney disease, diabetes, and mental health disorders, were particularly affected by Hurricane Maria. Study Purpose: We compare the quality of dialysis facilities in Puerto Rico before and after Hurricane Maria, examining factors influencing differences compared to five mainland US states. Methods: Using data from Dialysis Facility Compare (DFC) and the Master Beneficiary Summary File (MBSF), we analyzed patient care ratings and migration patterns of Puerto Rican Medicare beneficiaries with end-stage renal disease (ESRD). We assessed 4,469 unique dialysis facilities, spanning 19,507 facility years, before and after Hurricane Maria (2015-2024). The study's main outcome was mean star rating and identifying the percentage of dialysis facilities with a mean star rating of four or more derived from the publicly available DFC dataset on quality of patient care rating before and after Hurricane Maria (2015-2024). Results: There was a significant difference in the quality of dialysis facilities measured by mean star ratings (1-5) between Puerto Rico and the five mainland US states from 2015 to 2023 (p < 0.001). The findings also indicated a difference in the percentage of high-quality dialysis facilities between 2015 and 2023 in Puerto Rico compared to the five mainland US states. Conclusion: Before and after Hurricane Maria, we found significant disparities in the quality of dialysis facilities in Puerto Rico compared to those in the five mainland US states we studied. The decline in mean star ratings of dialysis facilities after Hurricane Maria in 2023 may be attributed to various reasons such as the ESRD Treatment Choices Model (2023), 21st Century Cures Act, CMS Methodology Update (October 2023), and the impact of the COVID-19 pandemic. Addressing these disparities requires policymakers to prioritize equitable healthcare access and implement targeted interventions in Puerto Rico.
Notes:: Thesis (M. P. H.)--Brown University, 2024

Content

Citation

Beheshtian, Kiana, "Examining Disparities in Quality of Dialysis Facilities in Puerto Rico vs. Five Mainland US States Before and After Hurricane Maria (2015-2023)" (2024). Public Health Theses and Dissertations. Brown Digital Repository. Brown University Library. https://repository.library.brown.edu/studio/item/bdr:c6kdpkd6/

Relations

Collection:

Public Health Theses and Dissertations

Theses and Dissertations for the Public Health department.
...