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Rehospitalization after Renal Transplant: Patterns, Predictors, & Implications

肾移植后再住院：模式、预测因素、

基本信息

批准号：
8526725
负责人：
Meera Nair Harhay
金额：
$ 7.33万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-06-30 至 2014-06-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8526725
关键词：
Address Adult Adverse effects Age Agreement Allografting Ambulatory Monitoring Blood Pressure Caring Categories Cessation of life Clinical Cohort Studies Complex Congestive Data Development Disease Epidemiology Event Failure Foundations Future Glucose Goals Grant Healthcare Heart Hospitals Immunosuppression Institution Instruction Intervention K-Series Research Career Programs Kidney Failure Kidney Transplantation Lead Logistic Regressions Manuscripts Master of Science Measures Medical Medical Records Medical center Medicare Methods Metric Minority Modeling Narcotics Operative Surgical Procedures Organ Outcome Outcomes Research Patient Care Patients Pattern Pennsylvania Pharmaceutical Preparations Physiological Population Process Prospective Studies Publications Publishing Quality of Care Regimen Research Research Design Research Personnel Research Project Grants Resources Risk Risk Factors Subgroup Surgical complication Testing Transplant Recipients Transplantation Transplanted Kidney Complication United States Centers for Medicare and Medicaid Services Universities adverse outcome base body system clinical epidemiology cohort cost delayed graft function demographics design experience follow-up high risk improved medical complication modifiable risk mortality prevent prognostic programs public health relevance skills statistics tool

项目摘要

DESCRIPTION (provided by applicant): Early rehospitalization following transplantation is a common and costly event among kidney transplant recipients (KTRs). While this outcome has been identified as a quality of care metric for hospitals by the Centers for Medicare & Medicaid Services, it is not known whether early rehospitalizations after kidney transplant represent preventable events. A national study of Medicare-covered recipients who underwent renal transplant in 2005 revealed that over half were rehospitalized in the first six months, at a cost o 339 million dollars to Medicare.1 Identifying risk factors for rehospitalization and developing interventions to prevent rehospitalization have been a focus of many studies in patients with a variety of diagnoses2 from congestive heart failure3 to pneumonia.4 In KTRs, however, few data exist about the specific patterns and causes of early (defined as <30 days) rehospitalization following kidney transplantation. The central premise of this grant is that give the substantial baseline risks of kidney failure and transplantation, only a minority of early rehospitalizations after kidney transplantation is preventable. We also hypothesize that early rehospitalization predicts future risk of later adverse outcomes including graft loss and death. We propose a retrospective cohort study of KTRs using detailed data from a single center. The study design will enable the applicant to achieve the following Specific Aims: 1) To determine categories of reasons for early rehospitalization after renal transplantation based on expert in-depth review, and to classify these causes according to preventability; 2) To determine predictors of early rehospitalization; and 3) To determine if early rehospitalization is an independent predictor of later adverse outcomes (mortality, graft loss). The results of this study have the potential to improve patient care after kidney transplantation by identifying important modifiable process-of-care factors that increase rehospitalization risk. We will develop a prediction model for early rehospitalization that we will externally validate in a cohort of KTRs a other transplant centers. We will also determine if early rehospitalization is an independent predictor of later allograft loss, as it may prove to be an easily measured prognostic tool for clinicians. The proposed research project will be in the context of completing the Masters of Science in Clinical Epidemiology degree at the University of Pennsylvania. The degree program encompasses intensive instruction on the fundamentals of epidemiology and analytic methods; this coursework will enhance and guide the research process of the applicant. The longer-term objectives of the applicant for this grant are to prepare presentations and manuscripts for publication, apply the results to the design of future prospective studies, and use this study as the foundation of a future K-award application.

描述（由申请人提供）：移植后早期再住院是肾移植受者（KTR）中常见且昂贵的事件。虽然这一结果已被医疗保险和医疗补助服务中心确定为医院的护理质量指标，但尚不清楚肾移植后早期再住院是否代表可预防的事件。一项对2005年接受肾移植的医疗保险接受者的全国性研究显示，超过一半的人在头六个月内再次住院，医疗保险花费了3.39亿美元。1识别再住院的风险因素和开发预防再住院的干预措施已经成为许多研究的焦点，这些研究针对的是患有各种诊断2的患者，从充血性心力衰竭3到肺炎。4在KTR中，然而，关于肾移植后早期（定义为<30天）再住院的具体模式和原因的数据很少。该补助金的中心前提是，考虑到肾衰竭和移植的基本风险，只有少数肾移植后早期再住院是可以预防的。我们还假设早期再住院可以预测包括移植物丢失和死亡在内的后期不良结局的未来风险。我们提出了一个回顾性队列研究的KTR使用详细的数据从一个单一的中心。研究设计将使申请人能够实现以下特定目的：1）根据专家深入审查确定肾移植术后早期再住院的原因类别，并根据可预防性对这些原因进行分类; 2）确定早期再住院的预测因素;和3）确定早期再住院是否是后期不良结局（死亡率、移植物丢失）的独立预测因子。这项研究的结果有可能通过确定增加再住院风险的重要可修改的护理过程因素来改善肾移植后患者的护理。我们将开发一个早期再住院的预测模型，我们将在其他移植中心的KTR队列中进行外部验证。我们还将确定早期再住院是否是后期同种异体移植物丢失的独立预测因素，因为它可能被证明是临床医生容易测量的预后工具。拟议的研究项目将在宾夕法尼亚大学完成临床流行病学硕士学位的背景下进行。该学位课程包括对流行病学和分析方法的基础知识的强化教学;本课程将加强和指导申请人的研究过程。申请人的长期目标是准备演讲和手稿出版，将结果应用于未来前瞻性研究的设计，并将本研究作为未来K奖申请的基础。