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Investigating the Economic and SocialDeterminants of Home Dialysis Drop-Out

调查家庭透析退出的经济和社会决定因素

基本信息

批准号：
10413020
负责人：
Eugene Lin
金额：
$ 17.09万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10413020
关键词：
Address Award Data Databases Development Plans Dialysis patients Dialysis procedure Dropout Drops Economics End stage renal failure Ensure Funding Future Goals Health Care Costs Health Policy Health Services Hemodialysis Home Home Hemodialysis Incentives Information Systems Kidney Kidney Diseases Knowledge Lead Light Medicare claim Mentorship Methods Modality Patient Care Patient Recruitments Patients Peritoneal Dialysis Personal Satisfaction Policies Policy Maker Prospective Payment System Provider Quality of life Research Research Personnel Risk Science Self Care Societies Techniques Testing Time Training United States Work burnout care delivery career career development comorbidity cost cost effective design econometrics economic determinant experience financial incentive high risk improved models and simulation multidisciplinary older patient payment prevent programs simulation skills social determinants societal costs

项目摘要

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.

7.项目摘要/摘要本K 08提案旨在为尤金林博士（医学博士、理学硕士）提供受保护的时间、培训、指导，研究经验，使他成为一个独立的卫生服务研究人员在肾脏疾病。作为作为一名学术肾病学家，林博士的研究重点是卫生政策问题和有效的护理服务与肾脏疾病有关，特别是透析。家庭透析为患者提供独立性，提高生活质量，降低社会成本。然而，许多患者选择从家里转来透析到中心透析，特别是当他们没有得到足够的支持或充分准备。这种家庭透析的退出是昂贵的，并且是患者和社会健康的潜在损失。存在近期终末期肾病透析付费改革前瞻性付费系统（PPS）通过使其相对于中心内更有利可图，促进了家庭透析使用的增加透析然而，目前尚不清楚支付改革是否同时激励了招募患者，更有可能辍学，或者如果它导致设施的出现，透析此外，关于减少家庭透析脱落的潜在解决方案知之甚少。为了解决这个知识差距，本研究旨在：（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组成的变化接受家庭透析，和（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。林博士将通过应用计量经济学技术应用于大型索赔数据库并开发患者动态模拟模型接受家庭透析该提案极有可能对患者护理产生重大影响，这可能会改变医疗机构对家庭透析患者的管理方式。研究支付改革的影响还将帮助决策者更好地了解其影响，并将有助于为设计和完善旨在改善家庭透析服务的未来政策。为了实现这些目标，林博士将获得在多学科导师的指导下，进行计量经济学和设计科学方面的额外培训团队所提出的工作和职业发展计划在奖励期内是现实可行的，将确保林博士发展的技能，以竞争R 01的资金。简而言之，K 08奖将提供培训，研究经验和指导需要帮助林博士成功地过渡到一个独立的卫生服务研究员。

项目成果

期刊论文数量（25）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Association Between Nephrologist Ownership of Dialysis Facilities and Clinical Outcomes.

肾科医生拥有透析设施与临床结果之间的关联。

DOI：
10.1001/jamainternmed.2022.5002
发表时间：
2022
期刊：
JAMA internal medicine
影响因子：
39
作者：
Lin,Eugene;McCoy,MatthewS;Liu,Manqing;Lung,KhristinaI;Rapista,Derick;Berns,JeffreyS;Kanter,GenevieveP
通讯作者：
Kanter,GenevieveP

Disparities in the Timing of Preoperative Hemodialysis Among Patients With End-Stage Kidney Disease.

DOI：
10.1001/jamanetworkopen.2023.26326
发表时间：
2023-07-03
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
Fielding-Singh, Vikram;Vanneman, Matthew W.;Morris, Arden M.;Chertow, Glenn M.;Lin, Eugene
通讯作者：
Lin, Eugene

What the Comprehensive ESRD Care Program Tells Us About the Advancing American Kidney Health Initiative.

综合 ESRD 护理计划告诉我们有关推进美国肾脏健康计划的信息。

DOI：
10.1053/j.ajkd.2020.05.011
发表时间：
2020
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
0
作者：
Khine,Annika;Lin,Eugene
通讯作者：
Lin,Eugene

Challenging Assumptions of Outcomes and Costs Comparing Peritoneal and Hemodialysis.

DOI：
10.1016/j.jval.2021.05.017
发表时间：
2021-11
期刊：
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
影响因子：
0
作者：
Lin E;Lung KI;Chertow GM;Bhattacharya J;Lakdawalla D
通讯作者：
Lakdawalla D

A Blueprint for Assessing Affordability of SGLT2 Inhibitors in the United States: The Cost-Effectiveness of Dapagliflozin in Three European Countries.

美国 SGLT2 抑制剂可承受性评估蓝图：达格列净在三个欧洲国家的成本效益。