Investigating the Economic and SocialDeterminants of Home Dialysis Drop-Out

7.项目总结/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。林博士将通过应用实现这些研究目标 计量经济学技术的大型索赔数据库，并通过开发一个动态模拟模型的病人 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 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。

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.