Home-based conservative care model for advanced kidney disease

晚期肾病的家庭保守治疗模式

• 批准号: 10535360
• 负责人: Susan Pamela Wong
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10535360
• 关键词: Accident and Emergency department; Address; Admission activity; Advance Care Planning; Age; Caregiver Burden; Caregivers; Caring; Cessation of life; Chronic Disease; Chronic Kidney Failure; Collaborations; Complex; Computer software; Data; Data Analyses; Developed Countries; Dialysis procedure; Disease; Disease Progression; Dose; Elements; Enrollment; Ethnography; Family; Geriatrics; Goals; Health; Health Care Costs; Health Personnel; Healthcare; Healthcare Systems; Home; Hospitalization; Improve Access; Infrastructure; Inpatients; Investigation; Kidney; Kidney Diseases; Life; Life Style; Link; Long-Term Care; Maintenance; Measures; Medical Records; Medicare; Methodology; Minority; Modeling; Natural Language Processing; Nursing Homes; Observational Study; Outcome; Outpatients; Palliative Care; Patient Care; Patients; Pattern; Persons; Physical Function; Pilot Projects; Policy Maker; Primary Care; Publications; Quality of life; Randomized; Readiness; Renal function; Research Methodology; Retrospective cohort; Surveys; Symptoms; Therapeutic; Veterans; Veterans Hospitals; acceptability and feasibility; aged; career networking; cognitive function; comorbidity; comparative effectiveness trial; cost; end of life; evidence base; health care availability; health care service utilization; hospice environment; human old age (65+); improved; innovation; interdisciplinary approach; member; multidisciplinary; multiple chronic conditions; novel; older patient; patient oriented; pilot test; pilot trial; preference; programs; satisfaction; sound; symposium; symptom management; treatment as usual

PROJECT SUMMARY/ABSTRACT Background: Conservative care (CC) is an important therapeutic option for Veterans who do not wish to pursue maintenance dialysis for their advanced chronic kidney disease (CKD) and offers a whole-person, multidisciplinary approach to care that is focused on slowing disease progression, active symptom management, advance care planning, and provision of appropriate palliative care. Recent evidence from observational studies of CC programs in other developed countries indicate that for older patients (aged ≥75 years) with significant comorbidity and functional limitation, dialysis may not meaningfully lengthen survival or improve quality of life beyond what can be achieved with CC. Although 1 in 7 Veterans with advanced CKD do not pursue dialysis, there are no formal CC programs within the VA and few, if any, concerted efforts to establish these programs in non-VA settings. While CC programs do not currently exist in the VA, many of the elements of CC programs found in other developed countries and that are desirable to Veterans, families, and healthcare providers can be found in the VA’s Home-Based Primary Care (HBPC) program. HBPC provides home-based multidisciplinary primary care to Veterans with multimorbidity and functional limitation with the goal of supporting Veterans’ quality of life and mitigating the complications of illness through to the end of life. We hypothesize that the multidisciplinary care (MDC) framework of HBPC serves as the ideal starting ground to build the VA’s first CC program for Veterans with advanced CKD. Significance: The current proposal is a collaboration with operational partners in HBPC, VA Geriatrics and Extended Care Data Analysis Center, and the VA National Kidney Program. It addresses HSRD priorities of improving access to care, healthcare values, management of complex chronic illness, and long-term care by increasing the evidence base for HBPC and filling outstanding care gaps for Veterans with advanced CKD. Innovation and Impact: The proposal will lead to: 1) the first comprehensive investigation of CKD-relevant outcomes associated with receipt of HBPC; and 2) the creation of the first evidence-based CC program for Veterans with advanced CKD in the VA, if not the nation. Specific Aims: Aim 1: To evaluate the impact of the HBPC MDC model on CKD-specific outcomes; and Aim 2: To assess the feasibility and acceptability of a novel CC Program delivered through the MDC infrastructure of HBPC among Veterans with advanced CKD, their caregivers and clinicians and explore preliminary outcomes of this Program. Methodology: Aim 1 is an emulated hypothetical comparative effectiveness “trial” using observational data for a national retrospective cohort of Veterans with advanced CKD. We will use linked VA and Medicare data and augmented VA medical record review using novel natural language processing software to determine the impact of different patterns of MDC provided by HBPC on downstream treatment practices for advanced CKD. Aim 2 is a randomized pilot trial of 30 Veterans with advanced CKD, their caregivers and clinicians using ethnographic research methods to assess the feasibility and acceptability of a novel CC Program for advanced CKD delivered through the existing MDC infrastructure of the HBPC program at VA Puget Sound Health Care System. We will also use medical record review and serial surveys to collect information on CKD progression, quality of life, goal concordant care, caregiver burden, clinician effort, and healthcare utilization and costs. Next Steps: Our proposal is a foundational and necessary step in our efforts to expand treatment options for advanced CKD and to create a scalable, sustainable, and effective model of CC for Veterans with advanced CKD. The findings will be widely disseminated through publications, presentations at national conferences and professional networks of the study team members who are highly connected with policy makers at national VA agencies.

项目摘要/摘要 背景：保守治疗（CC）是一个重要的治疗选择的退伍军人谁不希望 为他们的晚期慢性肾病（CKD）进行维持性透析，并提供一个完整的人， 多学科的护理方法，重点是减缓疾病进展， 管理，提前护理规划，并提供适当的姑息治疗。的最新证据 在其他发达国家进行的CC项目的观察性研究表明，对于老年患者（年龄≥75岁）， 年），透析可能不会有意义地延长生存期， 提高生活质量，超越CC所能达到的水平。尽管1/7的晚期CKD退伍军人 不进行透析，VA内部没有正式的CC计划，并且很少（如果有的话）共同努力， 在非VA设置中建立这些程序。虽然CC程序目前不存在于VA，许多 在其他发达国家发现的CC计划的元素，是可取的退伍军人，家庭， 医疗保健提供者可以在VA的家庭初级保健（HBPC）计划中找到。HBPC提供 家庭多学科初级保健，以退伍军人与多morphies和功能限制， 支持退伍军人的生活质量和减轻疾病并发症的目标，直到生命的尽头。 我们假设HBPC的多学科护理（MDC）框架是理想的起点 建立退伍军人管理局的第一个CC计划，为退伍军人与先进的CKD。意义：目前的提案是一项 与HBPC、VA老年医学和扩展护理数据分析中心的运营合作伙伴合作， VA国家肾脏计划它解决了HSRD的优先事项，即改善获得护理的机会，医疗保健价值， 通过增加HBPC的证据基础来管理复杂的慢性病和长期护理， 为患有晚期CKD的退伍军人填补了突出的护理空白。创新和影响：该提案将引领 至：1）首次全面调查与接受HBPC相关的CKD相关结局;和2） 为退伍军人中患有晚期CKD的退伍军人创建第一个循证CC计划，如果不是 民族具体目的：目的1：评价HBPC MDC模型对CKD特异性结局的影响; 目标2：评估通过MDC提供的新型CC计划的可行性和可接受性 HBPC在患有晚期CKD的退伍军人及其护理人员和临床医生中的基础设施，并探索 该计划的初步成果。方法：目标1是一个模拟的假设比较 有效性“试验”使用的观察数据为国家回顾性队列的退伍军人与先进的 CKD。我们将使用关联的VA和Medicare数据，并使用新的自然疗法进行增强的VA病历审查。 语言处理软件，以确定HBPC提供的MDC的不同模式对 晚期CKD的下游治疗实践。目标2是一项随机试点试验，30名退伍军人， 晚期CKD，他们的护理人员和临床医生使用人种学研究方法来评估可行性 通过现有MDC基础设施提供的晚期CKD新型CC计划的可接受性 在弗吉尼亚州普吉特湾医疗保健系统的HBPC计划。我们还将使用医疗记录审查， 系列调查，以收集关于CKD进展、生活质量、目标一致性护理、护理者 负担、临床医生的努力以及医疗保健利用率和成本。下一步：我们的建议是一个基础性的， 这是我们努力扩大晚期CKD治疗选择的必要步骤， 为患有晚期CKD的退伍军人提供可持续和有效的CC模式。调查结果将广泛 通过出版物、在国家会议上的介绍和联合国各组织的专业网络传播 研究小组成员与国家退伍军人事务机构的政策制定者有着密切的联系。