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Managing the Delivery of Dialysis Therapy: A Multiclass Fluid Model Analysis

Graduate School of Business, Stanford University, Stanford, California 94305
Closed Loop Solutions, Mountain View, California 94043
stefzen{at}leland.stanford.edu
pfuloria{at}cloop.com

Motivatedby the exceptionally high mortality statistics of dialysis patients and the ongoing debate about the adequacy of the current reimbursement for dialysis in the United States, we pursue a detailed analysis of the dialysis delivery system. The analysis is based on a multiclass fluid model for the dialysis facility, which combines a pharmacokinetics model of dialysis and an empirically validated model of dialysis-specific mortality. Assuming that the facility operates under budget and capacity constraints, our analysis determines the main factors that affect the delivery of dialysis. Numerical results, which are representative of the dialysis environment in the US, demonstrate the accuracy of the model and provide concrete insights about the operations of the dialysis facility. A major finding is that an improvement in the technology of dialysis is likely to have a more substantial impact on the overall life expectancy of the dialysis population as compared to an increase in the dialysis reimbursement rate.

Key Words: health services research; dialysis therapy; fluid models; optimal control theory; economic analysis
History: Received: September 25, 1998;

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