Publication Spotlight: Dr. Bicki

Interview with Alexandra Bicki, MD, MPH, Clinical Fellow in Pediatric Nephrology, University of California San Francisco, senior author of Dialysis Facility Staffing Ratios and Kidney Transplant Access Among Adolescents and Young Adults.

What question did your study aim to answer?

We aimed to answer the question “Are dialysis facility staffing ratios associated with waitlisting and kidney transplantation among adolescents and young adults receiving dialysis?” We specifically looked at these outcomes among people starting dialysis between age 12 and age 30, because adolescents and young adults can face a number of challenges in navigating healthcare systems, and may need more staff support from nurses and social workers as they proceed through the complex transplant evaluation process.

What inspired you to conduct this study?

I was drawn to the field of pediatric nephrology because it is so interdisciplinary. I know firsthand that the social workers and nurses on our chronic kidney disease, dialysis, and transplant teams provide such exceptional care to our patients and their families. We hypothesized that having adequate non-physician staff members would be related to whether or not these patients were waitlisted and eventually received a transplant.

Which USRDS datasets did you use to conduct your study?

We used the USRDS Standard Analysis Files to conduct our study.

Using plain language, please summarize your study conclusions in two or three points.

• In general, we found that higher staffing ratios (more patients per staff member) were associated with lower incidence of waitlisting and transplantation for adolescents and young adults.
• We found that those receiving dialysis at facilities with the highest (as compared to the lowest) quartile of patient-to-social-worker ratios was associated with 5% lower incidence of waitlisting.
• We also found that receiving dialysis at facilities with the highest (as compared to the lowest) quartile of patient-to-nurse or patient-to-social-worker ratios was associated with a 14-15% lower incidence of later getting a transplant.

Please share a specific insight about working with USRDS data that you learned during the completion of this study.

With such longitudinal data available in the USRDS, we were able to adjust our analyses to account for whenever patients changed their primary dialysis facility, to ensure our findings were robust. I was fortunate to work with and learn from a number of colleagues with extensive experience in using the data.