A mixed-methods investigation of incident Hemodialysis access in a safety-net population.
A mixed-methods investigation of incident Hemodialysis access in a safety-net population.
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DOI：
10.1186/s12882-017-0700-9
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发表时间：
2017-09-02
期刊：
影响因子：
2.3
通讯作者：
Tuot DS
中科院分区：
文献类型：
--
作者：
Rich NC;Vartanian SM;Sharief S;Freitas DJ;Tuot DS
尽管与动静脉瘘相关的健康结果有所改善，但80%的美国人开始使用导管进行血液透析，这受到社会经济地位低等因素的影响。安全网人群中导管使用事件的风险因素未知。我们的目的是确定与一家安全网医院血液透析患者中导管使用事件相关的因素，目的是更广泛地为安全网人群提供瘘管放置计划。我们对2010年1月1日至2015年12月31日在一家城市安全网医院（n = 241）的所有血液透析患者进行了回顾性分析，并对来自该队列的多语言便利样本患者（n = 10）进行了半结构化访谈。主要结局为血管通路模式事件。多变量逻辑回归用于确定与导管使用事件相关的因素。访谈记录进行编码使用定向内容分析框架的基础上描述的障碍，以获得医疗保健的模型。61.8%的受试者为男性，种族/人种多样化（19.5%为白色，29.5%为黑人，28.6%为西班牙裔，17.4%为亚裔），平均年龄为52.4岁。88%的患者开始使用导管进行血液透析。在多变量分析中，较长的肾病护理持续时间与导管使用减少相关（>12个月vs. 0-6个月：调整后的比值比[aOR] 0.07，95% CI 0.02-0.23，p < 0.001），而无保险状态增加了导管使用的几率（aOR 3.96，1.23-12.76，p = 0.02）。在血管外科手术服务在医院可用后，导管使用减少（OR 0.40，95% CI 0.16-0.98，p = 0.04），但在多变量分析中，该相关性不显著（aOR 0.48，0.17-1.36，p = 0.17）。在访谈中，患者提到对疾病的情绪反应、缺乏社会和财政资源以及健康知识有限是获得瘘管手术的障碍。在这个城市安全网人口中，导管使用率高于全国平均水平。获得健康保险、早期转诊到肾病科以及提供住院血管手术应在安全网中优先考虑。此外，支持患者情感和学习需求的服务可能会减少瘘管放置的延误。
Despite improved health outcomes associated with arteriovenous fistulas, 80% of Americans initiate hemodialysis using a catheter, influenced by low socioeconomic status among other factors. Risk factors for incident catheter use in safety-net populations are unknown. Our objective was to identify factors associated with incident catheter use among hemodialysis patients at one safety-net hospital, with a goal of informing fistula placement initiatives targeted at safety-net populations more generally. We performed a retrospective review of all incident hemodialysis patients at a single urban safety-net hospital from January 1, 2010 - December 31, 2015 (n = 241), as well as semi-structured interviews with a multi-lingual convenience sample of patients (n = 10) from this cohort. The primary outcome was incident vascular access modality. Multivariable logistic regression was used to identify factors associated with incident catheter use. Interview transcripts were coded using a directed content analysis framework based on a model describing barriers to healthcare access. Subjects were 61.8% male, racially/ethnically diverse (19.5% white, 29.5% black, 28.6% Hispanic, 17.4% Asian), with a mean age of 52.4 years. Eighty-eight percent initiated hemodialysis using a catheter. In multivariable analysis, longer duration of nephrology care was associated with decreased catheter use (>12 months vs. 0–6 months: adjusted Odds Ratio [aOR] 0.07, 95% CI 0.02–0.23, p < 0.001), whereas uninsured status increased odds of catheter use (aOR 3.96, 1.23–12.76, p = 0.02). There was a decrease in catheter use after vascular surgery services became available in-hospital (OR 0.40, 95% CI 0.16–0.98, p = 0.04), however this association was not significant in multivariable analysis (aOR 0.48, 0.17–1.36, p = 0.17). During interviews, patients cited emotional responses to disease, lack of social and financial resources, and limited health knowledge as barriers to obtaining fistula surgery. The rate of catheter use in this urban safety-net population is above the national average. Access to health insurance, early referrals to nephrology, and provision of in-hospital vascular surgery should be prioritized in the safety-net. Additionally, services that support patients’ emotional and learning needs may decrease delays in fistula placement.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
DOI：
10.2215/cjn.00640109
发表时间：
2009-11-01
影响因子：
9.8
作者：
Miskulin, Dana;Bragg-Gresham, Jennifer;Port, Friedrich K.
通讯作者：
Port, Friedrich K.
影响因子：
4.6
作者：
Nee, Robert;Yuan, Christina M.;Abbott, Kevin C.
通讯作者：
Abbott, Kevin C.
影响因子：
1.3
作者：
Patibandla, Bhanu K.;Narra, Akshita;Goldfarb-Rumyantzev, Alexander S.
通讯作者：
Goldfarb-Rumyantzev, Alexander S.
影响因子：
4.2
作者：
Wasse, Haimanot;Hopson, Sari D.;McClellan, William
通讯作者：
McClellan, William