Understanding the Initiation of Maintentenance Dialysis among Older Veterans

了解老年退伍军人维持透析的开始

• 批准号: 10181033
• 负责人: MANJULA KURELLA TAMURA
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10181033
• 关键词: Age; Caring; Characteristics; Clinical; Continuity of Patient Care; Data; Decision Making; Dialysis patients; Dialysis procedure; Elderly; End stage renal failure; Goals; Growth; Health Resources; Incidence; Intervention; Laboratories; Life Expectancy; Maintenance; Medicare; Nephrology; Older Population; Outcome; Patients; Pattern; Policies; Prevalence; Procedures; Provider; Records; Resources; Services; Source; Subgroup; Variant; Veterans; cohort; comorbidity; design; end of life; functional status; health care service utilization; improved; medical specialties; medical supply; novel; preference; shared decision making; therapy design; treatment choice; treatment strategy

DESCRIPTION (provided by applicant): The decision to initiate maintenance dialysis for older veterans with end-stage renal disease affords one of the greatest opportunities to improve value in specialty care. Similar to other intensive procedures performed near the end of life, there are wide regional variations in the utilization of dialysis among older adults, suggesting that intensity of treatment for end-stage renal disease is determined by practice style or the supply of medical resources rather than the likelihood of benefit. The goal of this project is to determine the sources of variation underlying the decision to initiate dialysis and to identify specific patient, provider and facility characterstics associated with receipt of dialysis versus conservative (non-dialytic) care. This project will also compare the survival and health resource utilization patterns of dialysis versus conservative care management strategies. To accomplish this goal, we will assemble a national cohort of veterans approaching end-stage renal disease using VA claims data, laboratory records and detailed chart review. The findings from this project will inform the design of interventions and VA policies that promote appropriate use of dialysis.

描述（由申请人提供）： 决定为患有末期肾脏疾病的老年退伍军人启动维护透析的决定是提高专业护理价值的最大机会之一。与在生命快要结束时执行的其他密集程序类似，在老年人中，透析的利用情况有很大变化，这表明对终末期肾脏疾病的治疗强度取决于实践风格或医疗资源的供应，而不是受益的可能性。该项目的目的是确定依据的差异来源 决定启动透析并确定与透析与透析与保守（非差异）护理相关的特定患者，提供者和设施特征的决定。这个项目也将 比较透析与保守的护理管理策略的生存和健康资源利用模式。为了实现这一目标，我们将使用VA索赔数据，实验室记录和详细的图表审查来组装一群国家的退伍军人，以接近末期肾脏疾病。该项目的发现将为促进适当使用透析的干预措施和VA政策的设计提供信息。

项目成果

Epidemiology and Public Health Concerns of CKD in Older Adults.

• DOI: 10.1053/j.ackd.2015.10.001
• 发表时间: 2016-01
• 期刊: Advances in chronic kidney disease
• 影响因子: 2.9
• 作者: Fung E;Kurella Tamura M
• 通讯作者: Kurella Tamura M

Receipt of Nephrology Care and Clinical Outcomes Among Veterans With Advanced CKD.

• DOI: 10.1053/j.ajkd.2017.06.025
• 发表时间: 2017-11
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation
• 作者: Fung E;Chang TI;Chertow GM;Thomas IC;Asch SM;Kurella Tamura M
• 通讯作者: Kurella Tamura M

Facility-Level Variation in Dialysis Use and Mortality Among Older Veterans With Incident Kidney Failure.

• DOI: 10.1001/jamanetworkopen.2020.34084
• 发表时间: 2021-01-04
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Bradshaw C;Thomas IC;Montez-Rath ME;Lorenz KA;Asch SM;Leppert JT;Wang V;O'Hare AM;Kurella Tamura M
• 通讯作者: Kurella Tamura M

Medical Record Documentation of Goals-of-Care Discussions Among Older Veterans With Incident Kidney Failure.

• DOI: 10.1053/j.ajkd.2019.07.024
• 发表时间: 2020-05
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation
• 作者: Bradshaw CL;Gale RC;Chettiar A;Ghaus SJ;Thomas IC;Fung E;Lorenz K;Asch SM;Anand S;Kurella Tamura M
• 通讯作者: Kurella Tamura M

Nephrology Referral Based on Laboratory Values, Kidney Failure Risk, or Both: A Study Using Veterans Affairs Health System Data.

• DOI: 10.1053/j.ajkd.2021.06.028
• 发表时间: 2022-03
• 期刊: American journal of kidney diseases : the official journal of the National Kidney Foundation