DIALYSIS CARE: CHOICES, OUTCOMES, COSTS AND TRADEOFFS

透析护理：选择、结果、成本和权衡

• 批准号: 2445393
• 负责人: NEIL R. POWE
• 金额: $ 142.42万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-07-01 至 1999-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2445393
• 关键词: Medicare /Medicaid; chronic renal failure; continuous ambulatory peritoneal dialysis; health care cost /financing; health care policy; health care service utilization; hemodialysis; human morbidity; human mortality; human subject; human therapy evaluation; longitudinal human study; medical complication; outcomes research; patient care management; quality of life

End Stage Renal Disease (ESRD) is a devastating chronic illness which affects nearly 200,000 patients each year in the United States. The average annual per-patient cost of treatment is nearly $30,000, nine to ten times that of an average individual. The aggregate cost of ESRD care, $7 billion, is growing rapidly due to increasing enrollment of patients age 65 and older. Despite the benefits of kidney transplantation, a limited pool of donors and comorbid disease obligates most ESRD patients to chronic dialysis. This care is performed on an ambulatory basis. Choices of dialysis prescription, modality and dose, by physicians and patients are fundamental to the care of ESRD patients, vary considerably in the U.S. and could have enormous cost implications given the large per-patient costs. The choice of therapy in routine practice should reflect a comprehensive understanding of outcomes and costs of alternative prescriptions, and of the tradeoffs which they entail. However, neither the outcomes, the costs nor the tradeoffs are characterized well. We have formed a multidisciplinary team to investigate factors that influence the choice of a particular dialysis prescription, to assess patient outcomes and costs of alternative dialysis prescriptions in the United States, and to formulate optimal dialysis strategies that take into account the perspectives of patients, providers and payers. Our research will include: 1) a national prospective cohort study of mortality, morbidity, symptoms, quality of life, patient satisfaction and costs associated with alternative dialysis prescriptions; 2) a cross- sectional and follow-up study of patient preferences for alternative prescriptions; 3) a cross-sectional survey of nephrologists and dialysis facility administrators to ascertain factors affecting the choice of therapy; 4) a study of the impact of resource utilization in outpatient dialysis on mortality, morbidity and overall costs for all facilities and facilities of different organizational types; and 5) an analysis of the cost-effectiveness of alternative prescriptions. This research will provide information that can be used by physicians and policymakers to guide and improve dialysis management in the United States.

终末期肾病（ESRD）是一种毁灭性的慢性疾病， 在美国每年影响近20万患者。 的 平均每位患者每年的治疗费用近3万美元，9至10万美元， 是普通人的十倍。 ESRD的总成本 护理，70亿美元，正在迅速增长，由于越来越多的入学率， 65岁及以上患者。 尽管肾脏的好处 移植，有限的供体库和共病疾病 大多数终末期肾病患者接受慢性透析。 这种护理是在一个 门诊基础 医生选择透析处方、方式和剂量， 患者是ESRD患者护理的基础， 在美国，并可能有巨大的成本影响，因为大 每个病人的成本。 常规实践中的治疗选择应 反映对成果和成本的全面理解， 替代处方，以及它们所带来的权衡。 然而，无论是结果、成本还是权衡， 特点很好。 我们已经组建了一个多学科团队来调查 影响特定透析处方的选择，以评估 患者结局和替代透析处方的成本 美国，并制定最佳的透析策略， 考虑到患者、提供者和支付者的观点。 我们 研究将包括：1）国家前瞻性队列研究， 死亡率、发病率、症状、生活质量、患者满意度和 与替代透析处方相关的成本; 2）交叉- 患者对替代疗法偏好的横断面和随访研究 处方; 3）肾科医生和透析的横断面调查 设施管理人员确定影响选择的因素， 4）门诊患者资源利用的影响研究 透析对所有设施的死亡率、发病率和总成本的影响， 不同组织类型的设施; 5）分析 替代处方的成本效益。 这项研究将提供可供医生使用的信息， 决策者指导和改善美国透析管理 States.