African Americans' Hemodialysis Treatment Adherence Data Assessment and Presentation: A Precision-Based Paradigm Shift to Support Quality Improvement Activities.
African Americans' Hemodialysis Treatment Adherence Data Assessment and Presentation: A Precision-Based Paradigm Shift to Support Quality Improvement Activities.
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DOI：
10.1016/j.xkme.2021.10.007
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发表时间：
2022-03
期刊：
影响因子：
3.9
通讯作者：
Cavanaugh KL
中科院分区：
文献类型：
--
作者：
Umeukeje EM;Ngankam D;Beach LB;Morse J;Prigmore HL;Stewart TG;Lewis JB;Cavanaugh KL
每周三次血液透析可导致充分的尿素清除;然而，维持性透析治疗患者的发病率和死亡率仍然高得不可接受，部分原因是不依从。非裔美国人接受透析治疗的肾衰竭患病率更高，透析不依从性更高，住院几率更高。我们假设，更精确的评估透析治疗依从性的方法将反映不依从的严重程度，区分不依从的模式，并为个性化行为干预的设计提供信息。回顾性队列研究。接受血液透析>90天的非裔美国患者。血液透析。透析依从性。使用点图显示透析出勤数据，根据错过和缩短的治疗进行分类，并检查模式。报告了描述性特征。在一项探索性分析中，使用普通最小二乘回归评估了透析治疗依从性与受试者特征之间的相关性。使用错过的透析分钟数和当前指标进行分析，以测量透析治疗依从性（即错过和缩短的治疗）。在113例接受透析治疗的非洲裔美国患者中，47%为男性;中位年龄为57岁（四分位距，46-70岁），中位透析年限为54个月（四分位距，22-90个月）。根据透析总遗漏分钟数排序行，点图显示不依从严重程度的梯度下降，新的透析治疗依从性分类如下：一致性透析不足、不一致性透析和一致性透析。这些类别中出现了不同的不依从性和异质性模式。年龄较大始终与更好的依从性相关，这是通过使用透析总遗漏分钟数以及遗漏和缩短治疗进行的分析确定的。研究结果虽然具有可复制性和范式转移性，但可能受限于较短的时间轴，重点关注接受透析治疗的非裔美国患者的依从性数据，并限于隶属于1个学术中心的透析单位。本研究提出了更精确和新颖的方法来测量和显示透析治疗依从性。这些发现为评估实际透析吸收引入了一种更加个性化的方法。识别独特的依从行为模式对于设计有效的行为干预措施和改善接受透析治疗的弱势非洲裔美国患者的结局非常重要。
Thrice-weekly hemodialysis can result in adequate urea clearance; however, the morbidity and mortality rates of patients treated with maintenance dialysis remain unacceptably high, partly because of nonadherence. African Americans have a higher prevalence of kidney failure treated with dialysis, greater dialysis nonadherence, and higher odds of hospitalization. We hypothesized that more precise ways of assessing dialysis treatment adherence will reflect the severity of nonadherence, distinguish patterns of nonadherence, and inform the design of personalized behavioral interventions. Retrospective cohort study. African American patients receiving hemodialysis for >90 days. Hemodialysis. Dialysis adherence. Dialysis attendance data were displayed using a dot plot, categorized based on missed and shortened treatments, and examined for patterns. Descriptive characteristics were reported. In an exploratory analysis, associations between dialysis treatment adherence and participant characteristics were evaluated using ordinary least squares regression. An analysis was performed using missed minutes of dialysis and current metrics for measuring dialysis treatment adherence (ie, missed and shortened treatments). Among 113 African American patients treated with dialysis, 47% were men; the median age was 57 years (interquartile range, 46-70 years), and the median dialysis vintage was 54 months (interquartile range, 22-90 months). With rows ordered based on the total missed minutes of dialysis, the dot plot displayed a decreasing gradient in the severity of nonadherence, with novel dialysis treatment adherence categories termed as follows: consistent underdialysis, inconsistent dialysis, and consistent dialysis. Distinct patterns of nonadherence and heterogeneity emerged within these categories. Older age was consistently associated with better adherence, as determined by the analyses performed using the total missed minutes of dialysis as well as missed and shortened treatments. The study findings, although replicable and paradigm-shifting, might be limited by the short timeline, focus on adherence data specific to African American patients treated with dialysis, and restriction to dialysis units affiliated with 1 academic center. This study presents more precise and novel ways of measuring and displaying dialysis treatment adherence. The findings introduce a more personalized approach for evaluating actual dialysis uptake. Identification of unique patterns of adherence behavior is important to inform the design of effective behavioral interventions and improve outcomes for vulnerable African American patients treated with dialysis.
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影响因子：
5.9
作者：
Barrera, Manuel, Jr.;Castro, Felipe G.;Strycker, Lisa A.;Toobert, Deborah J.
通讯作者：
Toobert, Deborah J.
影响因子：
4.6
作者：
Obialo, Chamberlain I.;Hunt, William C.;Zager, Phillip G.
通讯作者：
Zager, Phillip G.
影响因子：
4.9
作者：
Hill, Z;Kendall, C;Fernandez, M
通讯作者：
Fernandez, M
影响因子：
3.9
作者：
Ajit, R. R.;Fenerty, C. H.;Henson, D. B.
通讯作者：
Henson, D. B.
影响因子：
13.2
作者：
Daugirdas, John T.;Depner, Thomas A.;Weiner, Daniel E.
通讯作者：
Weiner, Daniel E.