Innovations in Population Health: Improving Outcomes for Patients with Chronic Kidney Disease.
Innovations in Population Health: Improving Outcomes for Patients with Chronic Kidney Disease.
复制标题
人口健康创新：改善慢性肾病患者的治疗结果。
DOI：
10.1089/pop.2023.0132
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发表时间：
2023
影响因子：
2.5
通讯作者：
Jhamb,Manisha
中科院分区：
文献类型：
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作者：
Jhamb,Manisha
(CKD)已成为一个日益严重的人口健康问题，影响着3700万美国人。1到2030年，估计每6名30岁及以上的成年人中就有1人患有CKD，其中黑人或西班牙裔的患病率更高。1医疗保险每年在CKD和终末期肾病（ESKD）上花费1240亿美元，1血液透析患者每人每年花费9万美元。2除了可能扩大先前存在的健康差距外，大流行对CKD产生了可衡量的影响。2019冠状病毒病（COVID-19）与住院患者的急性肾损伤直接相关，长期影响的问题尚未得到解决。COVID-19的间接影响包括相关慢性疾病（糖尿病和高血压）的护理延迟，粮食不安全以及由于向远程医疗的转变而可能扩大现有的数字鸿沟3。4从人群的角度来看，为CKD提供护理有两个主要挑战：（1）识别需要透析或移植的疾病进展风险。目前用于识别高危患者的预测工具尚未在常规临床实践中广泛采用。我们需要一个实时CKD风险预测器，该预测器集成到电子健康记录（EHR）中，便于轻松识别高风险患者。(2)缩小CKD护理的差距。今天，每一位肾病学家就有超过3000名CKD患者。初级保健医生（PCP）提供大部分护理。我们需要更有效的基于系统的资源，让PCP来管理这些复杂的患者。
(CKD) has become an increasingly serious population health issue that affects 37 million Americans. 1 By 2030, an estimated 1 in every 6 adults age 30 and over will have CKD, with greater prevalence among persons who identify as Black or Hispanic. 1 Medicare spends $124 billion per year on CKD and end-stage kidney disease (ESKD), 1 and $90,000 per patient/per year for those on hemodialysis. 2 In addition to potentially widening pre-existing health disparities, the pandemic has had a measurable impact on CKD. Coronavirus disease 2019 (COVID-19) is directly associated with acute kidney injury in hospitalized patients, and the question of long-term effects has yet to be resolved. Indirect effects of COVID-19 include delays in care for related chronic diseases (diabetes and hypertension), food insecurity, and potential widening of the existing digital divide3 due to a shift toward telemedicine. 4 From a population perspective, there are two main challenges to providing care for CKD:(1) Identifying those at risk for disease progression that will require dialysis or transplant. The current prediction tools to identify high-risk patients have not been widely adopted in routine clinical practice. We need a real-time CKD risk predictor that is integrated into the electronic health record (EHR) and facilitates easy identification of high-risk patients.(2) Closing gaps in CKD care. Today there are> 3000 patients with CKD for every nephrologist. Primary care physicians (PCPs) provide most of the care. We need more efficient systems-based resources for PCPs to manage these complex patients.