Veteran Access and Limitations to Organ Recovery (VALOR)

退伍军人器官恢复的机会和限制 (VALOR)

• 批准号: 10365618
• 负责人: Raymond J Lynch
• 金额: $ 58.49万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-10 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10365618
• 关键词: Adherence; Advocacy; Age; American; Area; Authorization documentation; Automated Clinical Decision Support; Awareness; Beds; Caring; Case Study; Cessation of life; Chronic; Clinical; Complex; Consensus; Continuity of Patient Care; Contractor; Data; Elderly; Electronic Health Record; Environment; Evaluation; Failure; Family; Federal Government; Funding; Gifts; Grant; Health; Health system; Healthcare; Hospital Administration; Hospitals; Human Resources; Institution; Intervention; Interview; Kidney; Laboratories; Laws; Life; Liver; Logic; Maps; Measures; Medical; Medical center; Medicine; Minority; Modeling; Monitor; National origin; Operative Surgical Procedures; Organ; Organ Donations; Organ Donor; Organ Procurements; Organ Transplantation; Organ failure; Organization and Administration; Outcome; Patient Care; Patients; Perception; Performance; Physicians; Physiological; Population; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Process; Provider; Quality of Care; Race; Recovery; Research; Risk Factors; Role; Rural; Sampling; Savings; Source; Standardization; Structure; Support System; Surveys; System; Transplantation; Underserved Population; United States; United States Department of Veterans Affairs; Veterans; Vulnerable Populations; Waiting Lists; authority; base; biomedical referral center; body system; care coordination; care outcomes; clinical decision support; cost; critical care nursing; disability; disadvantaged population; ethnic minority; experience; follow-up; health practice; improved; interest; marginalized population; meetings; military veteran; minority patient; older patient; organ procurement transplantation network; patient advocacy group; patient oriented; patient population; programs; prospective; racial minority; radiological imaging; response; rural area; screening; sociodemographics; support tools; symposium; virtual

Abstract: Deceased donors provide lifesaving gifts to patients with chronic organ failure. Organ donation occupies a unique position in American healthcare, as donation care is provided without cost to the patient or their family and is mandated to be provided without bias to age, disability, race, or national origin by federal contractors known as organ procurement organizations (OPOs). Previous regulatory measures of OPO performance did not allow adequate objectivity, reliability, and transparency into procurement practice and have been replaced by a new metric introduced by this study's authors. Analyses using this metric reveal that older persons, minorities, and those living in poor, rural, and remote areas receive lesser access to organ donation. Veterans Administration Medical Centers (VAMCs) represent the largest single hospital system in the United States, and serve a population recognized to be underserved in many aspects of health and medicine. We have developed preliminary data showing that VAMCs recover deceased donor organs at a rate of 4% that of non-VA hospitals. The basis for this disparity is unclear, but given the high concentration of vulnerable and underserved groups at VAMCs, there is a strong imperative to improve donation access for these patients. In this proposal, we will leverage VAMCs' unparalleled electronic health records (EHRs), which offer detailed information on longitudinal patient care and outcomes, to enumerate the potential supply of organ donors nationwide over a 10-year historical period. We will use physiologic, laboratory, and radiographic data to define potential donor quality and estimate transplant yields at varying levels of donation performance relative to non-VA hospitals. We will also interview patients, critical care nurses and physicians at VAMCs, and OPO personnel to gather their experiences and perceptions regarding barriers to more effective donor recovery from these institutions. We will use findings from these qualitative and VA EHR studies to inform a consensus conference on best practices for improved organ donation care at VAMCs in year 2 of our project. Based on the findings of the first two aims in this study, we will create a model for improved VAMC donation care using a large, nationally-representative sample of VAMCs and their attendant OPOs. We will introduce a clinical decision support tool into VA EHR to maximize referral of potential donors. Study staff will integrate with OPOs in responding to VAMC referrals, utilizing VA EHR sources to assist in evaluating patients for donation. Study coordinators will facilitate workflow between VAMC and OPO staff, supporting and monitoring adherence to best practices defined in the consensus conference. We will conduct a follow-up stakeholder meeting to assess perceptions of the pilot program's efficacy among VAMC providers, OPO staff, and veteran and patient advocacy groups from within the study area. Together, this study's findings will not only help to ameliorate disparities in veterans' access to donation care, but will inform efforts to standardize and improve donation care among other underserved populations.

翻译后摘要：已故捐赠者提供救命的礼物，慢性器官衰竭患者。器官捐献 在美国医疗保健中占据独特的地位，因为捐赠护理是免费提供给患者的， 他们的家庭，并授权提供无偏见的年龄，残疾，种族或民族血统，由联邦 器官采购组织（OPO）。OPO以往的监管措施 由于业绩不佳，采购做法缺乏足够的客观性、可靠性和透明度， 已经被这项研究的作者引入的新指标所取代。使用这一指标的分析表明， 老年人、少数民族以及生活在贫困、农村和偏远地区的人获得器官的机会较少 捐赠。退伍军人管理局医疗中心（VAMC）是美国最大的单一医院系统。 美国，并服务于被认为在健康和医学的许多方面服务不足的人口。 我们已经开发出的初步数据显示，VAMC以4%的速度回收死亡供体器官， 非VA医院。造成这种差异的原因尚不清楚，但鉴于弱势群体和 在VAMC的服务不足群体中，迫切需要改善这些患者的捐赠途径。 在本提案中，我们将利用VAMC无与伦比的电子健康记录（EHR）， 关于纵向患者护理和结果的详细信息，以列举器官的潜在供应 在10年的历史时期内，全国的捐助者。我们将使用生理学、实验室和放射学数据 确定潜在的供体质量，并在不同的供体表现水平下估计移植产量 相对于非医院。我们还将采访VAMC的患者、重症监护护士和医生， OPO人员收集他们的经验和看法，了解阻碍更有效的捐助者 从这些机构回收。我们将使用这些定性和VA EHR研究的结果， 在我们项目的第二年，就改善VAMC器官捐赠护理的最佳实践举行了共识会议。 基于本研究前两个目标的发现，我们将创建一个改进的VAMC模型 捐赠护理使用一个大的，全国代表性的样本VAMC和他们的服务OPO。我们将 在VA EHR中引入临床决策支持工具，以最大限度地推荐潜在供体。研究工作人员将 与OPO整合，以响应VAMC转诊，利用VA EHR资源协助评估患者 捐赠。研究协调员将促进VAMC和OPO工作人员之间的工作流程，支持和 监测对共识会议中定义的最佳实践的遵守情况。我们将进行后续调查 利益相关者会议，以评估VAMC提供者、OPO工作人员 以及研究区域内的退伍军人和患者倡导团体。 总之，这项研究的发现不仅有助于改善退伍军人获得捐赠的差距， 护理，但将告知标准化和改善其他服务不足人群的捐赠护理的努力。