This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (10)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Renal Diseases  • Dialysis  • Pediatrics  • Adolescent Medicine  • Alert me on articles by topic

Susan L. Furth, MD,PhD; Wenke Hwang, PhD; Ching Yang, MS; Alicia M. Neu, MD; Barbara A. Fivush, MD; Neil R. Powe, MD,MPH,MBA

JAMA. 2001;285:1027-1033.

Context  Children and adolescent patients with renal failure are frequently cared for by adult subspecialists. While peritoneal dialysis is used in less than 17% of adults with kidney failure, it is the preferred dialysis treatment for children. National data show that 45% of children receiving dialysis are treated with peritoneal dialysis and pediatric nephrologists report its use in 65% of patients receiving dialysis. Whether differences in peritoneal dialysis use among children are due to the pediatric experience of the clinician has not been examined.

Objective  To assess whether the pediatric experience of nephrologists directly affects treatment recommendations for children with kidney failure.

Design  Cross-sectional survey using 10 case vignettes per survey based on random combinations of 8 patient characteristics (age, sex, race, distance from facility, cause of renal failure, family structure, education, and compliance).

Setting and Participants  National random sample of office-, hospital-, and academic medical center–based adult and pediatric nephrologists, stratified by geographic region and conducted June to November 1999. Of 519 eligible physicians, 316 (61%) responded, including 191 adult and 125 pediatric nephrologists.

Main Outcome Measure  Treatment recommendations for peritoneal dialysis vs hemodialysis, compared based on nephrologists' pediatric experience.

Results  After controlling for patient characteristics, pediatric nephrologists were 60% more likely than adult nephrologists to recommend peritoneal dialysis for identical patients (odds ratio, 1.61; 95% confidence interval, 1.35-1.92). This was true regardless of dialysis training, years in practice, practice setting, geography, or patient characteristics.

Conclusions  Our data indicate that pediatric specialization of clinicians influences treatment recommendations for children and adolescents with end-stage renal disease. Referring children to adult subspecialists may lead to differences in treatment choices and processes of care.

Author Affiliations: Division of Pediatric Nephrology, Department of Pediatrics (Drs Furth, Neu, and Fivush and Ms Yang), Welch Center for Prevention, Epidemiology and Clinical Research (Drs Furth and Powe), Departments of Health Policy and Management (Drs Hwang and Powe), Epidemiology (Dr Powe), and Medicine (Dr Powe), The Johns Hopkins Medical Institutions, Baltimore, Md.

RELATED ARTICLE

February 28, 2001
JAMA. 2001;285(8):1097-1098.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?
Khawar et al.
CJASN 2007;2:1317-1328.
ABSTRACT | FULL TEXT  

Measuring the Quality of Physician Practice by Using Clinical Vignettes: A Prospective Validation Study
Peabody et al.
ANN INTERN MED 2004;141:771-780.
ABSTRACT | FULL TEXT  

Racial and Center Differences in Hemodialysis Adequacy in Children Treated at Pediatric Centers: A North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) Report
Leonard et al.
J. Am. Soc. Nephrol. 2004;15:2923-2932.
ABSTRACT | FULL TEXT