Investigating the Economic and SocialDeterminants of Home Dialysis Drop-Out

7.项目摘要/摘要 此K08计划旨在为医学博士Eugene Lin提供受保护的时间、培训、指导和 研究经验，使他能够成为肾脏疾病方面的独立卫生服务研究员。AS 作为一名学术肾病专家，林博士的研究重点是卫生政策问题和有效的医疗服务提供 与肾脏疾病，特别是透析有关的。家庭透析为患者提供独立性和 提高了生活质量，而且对社会来说成本更低。然而，许多患者选择离家出院 透析到中心透析，特别是当他们没有得到足够的支持或当他们没有得到足够的支持时 做好充分的准备。这种从家庭透析中辍学的人代价高昂，并可能对患者和社会健康造成损失- 是存在的。近期透析付费改革通过终末期肾病(ESRD)前瞻性付费 系统(PPS)催化了家庭透析使用量的增加，使其相对于中心内更有利可图 透析。然而，目前尚不清楚支付改革是否同时激励了招募那些 更有可能退出，或者如果这导致了设备较少的设施的出现，以支持在家的患者 透析。此外，人们对减轻家庭透析脱落的潜在解决方案知之甚少。要解决这个问题 知识缺口，这项研究的目的是：(1)量化ESRD PPS导致的家庭透析脱落的变化，(2) 确定提供家庭透析的设施类型的变化和患者构成的变化 接受家庭透析，以及(3)评估可能减少家庭透析脱落的潜在策略， 包括再培训和休养期。林博士将通过应用 大型索赔数据库的计量经济学技术和开发患者的动态模拟模型 正在进行家庭透析。这项提案极有可能通过以下方式对患者护理产生实质性影响 潜在地改变了设施管理家庭透析患者的方式。研究支付改革的影响 还将帮助政策制定者更好地了解其影响，并有助于为设计和完善 未来的政策旨在改善家庭透析的提供。为了实现这些目标，林博士将获得 在多学科指导下，提供计量经济学和设计科学方面的额外培训 一队。拟议的工作和职业发展计划在获奖期内是现实和可行的 将确保林博士培养竞争R01资金的技能。简而言之，这个K08奖项将提供 培训、研究经验和指导，帮助林博士成功过渡到一名 独立的卫生服务研究员。

7. PROJECT SUMMARY / ABSTRACT This K08 proposal aims to provide Dr. Eugene Lin, MD, MS, with the protected time, training, mentorship, and research experience to allow him to become an independent health services researcher in kidney diseases. As an academic nephrologist, Dr. Lin focuses his research on health policy issues and efficient care delivery pertaining to kidney diseases and, in particular, dialysis. Home dialysis offers patients independence and improved quality of life, and it is less costly to society. However, many patients choose to switch from home dialysis to in-center dialysis, especially when they do not receive adequate support or when they are not sufficiently prepared. This dropout from home dialysis is costly and a potential loss in patient and societal well- being. Recent dialysis payment reform through the end-stage renal disease (ESRD) Prospective Payment System (PPS) catalyzed an increase in home dialysis use, by making it more profitable relative to in-center dialysis. However, it is unclear if payment reform simultaneously incentivized the recruitment of patients who are more likely to drop out or if it led to the emergence of facilities less equipped to support patients on home dialysis. Additionally, little is known about potential solutions to mitigate home dialysis dropout. To address this knowledge gap, this study aims to: (1) quantify changes in home dialysis dropout due to the ESRD PPS, (2) identify changes in the types of facilities offering home dialysis and changes in the composition of patients receiving home dialysis, and (3) evaluate potential strategies that might decrease home dialysis dropout, including retraining and periods of respite. Dr. Lin will accomplish these research goals by applying econometric techniques to a large claims database and by developing a dynamic simulation model of patients undergoing home dialysis. This proposal is highly likely to make a substantial impact on patient care by potentially changing how facilities manage patients on home dialysis. Studying the impact of payment reform will also help policy makers better understand its effects and will help inform the design and refinement of future policies aimed at improving the provision of home dialysis. To accomplish these aims, Dr. Lin will receive additional training in econometrics and design science, under the guidance of a multi-disciplinary mentorship team. The proposed work and career development plan are realistic and feasible within the award period and will ensure that Dr. Lin develops the skills to compete for R01 funding. In short, this K08 award will provide the training, research experience, and mentorship needed to help Dr. Lin successfully transition into an independent health services researcher.