NEPHROLOGIST CARE AND OUTCOMES IN RENAL INSUFFICIENCY

描述：拟议的研究，对医疗保险和 新泽西州1987-1994年的医疗补助数据库将分析 终末期肾病患者血液透析前一年或 移植。除了分析索赔数据，这项研究还将 摘要初级病历以获取更多的临床细节。这个 研究的目的是：(1)研究年内的肾病专科医生服务 血液透析/移植前(HD/TX)；(2)研究专家的使用情况 按年龄、性别、社会经济地位和种族划分的护理变量 在HD/TX之前一年；以及(3)确定转诊模式是否在 HD/TX之前的一年与后一年的结果相关 HD/TX。 这项研究的重点是由该中心提供的时间安排和后续护理 肾病学家。它将研究：(1)肾科医生的使用如何因以下因素而变化 患者特征(年龄、性别、社会经济地位和种族)和 初级保健提供者的特征；(2)如何使用肾科医生 转诊影响疾病的临床病程和结果(死亡率、 住院率、血管通路操作频率和血液 输血)，调整合并症；(3)是否有不同的措施 病例组合的不同会产生不同的结果；(4)专科的使用 服务和医疗保健费用。

Description: The proposed study, a secondary analysis of Medicare and Medicaid databases in New Jersey from the years 1987-1994, will analyze utilization patterns of ESRD patients in the year prior to hemodialysis or transplantation. In addition to analyzing claims data, the study will abstract primary medical records to obtain greater clinical detail. The aims of the research are: (1) to study nephrologist services in the year prior to hemodialysis/transplant (HD/Tx); (2) to study use of specialist care variables by age, gender, socio-economic status, and race during the year prior to HD/Tx; and (3) to determine whether the referral patterns in the year prior to HD/Tx are associated with outcomes in the year after Hd/Tx. The study focuses on the timing and follow-up care provided by the nephrologist. It will examine: (1) how use of a nephrologist varies by patient characteristics (age, gender, socioeconomic status, and race) and primary care provider characteristics; (2) how the use of a nephrologist referral affects the clinical course of the disease and outcomes (mortality, rates of hospitalization, frequency of vascular access procedures and blood transfusion), adjusting for co-morbidities; (3) whether different measures of case mix will yield different results; and (4) the use of specialty services and health care costs.