The Dialysis Outcomes and Practice Patterns Study (DOPPS) Practice Monitor: rationale and methods for an initiative to monitor the new US bundled dialysis payment system

A new initiative of the United States (U.S.) Dialysis Outcomes and Practice Patterns Study (DOPPS), the DOPPS Practice Monitor (DPM) provides up-to-date data and analyses to monitor trends in dialysis practice during implementation of the new Centers for Medicare and Medicaid Services (CMS) End-Stage Renal Disease (ESRD) Prospective Payment System (PPS; 2011–2014). We review DPM rationale, design, sampling approach, analytic methods, and facility sample characteristics. Using stratified random sampling, the sample of ~145 U.S. facilities provides results representative nationally and by facility type (dialysis organization size, rural/urban, free-standing/hospital-based), achieving coverage similar to the CMS sample frame at average values and tails of the distributions for key measures and patient characteristics. A publicly available Web report (www.dopps.org/DPM) provides detailed trends including demographic, comorbidity, and dialysis data, medications, vascular access, and quality of life. Findings are updated every 4 months and lagged only 3–4 months. Baseline data are from mid-2010, prior to the new PPS. In sum, the DPM provides timely, representative data to monitor the effects of the expanded PPS on dialysis practice. Findings can serve as an early warning system for possible adverse effects on clinical care and as a basis for community outreach, editorial comment, and informed advocacy.