Investigating the Economic and Social Determinants of Home Dialysis Drop-Out

调查家庭透析退出的经济和社会决定因素

• 批准号: 9762902
• 负责人: Eugene Lin
• 金额: $ 17.09万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9762902
• 关键词: Address; Award; Comorbidity; Data; Databases; Development Plans; Dialysis patients; Dialysis procedure; Dropout; Drops; Economics; End stage renal failure; Ensure; Funding; Future; Goals; Health Care Costs; Health Policy; Health Services; Hemodialysis; Home Hemodialysis; Home environment; Incentives; Information Systems; Kidney; Kidney Diseases; Knowledge; Lead; Light; Medicare claim; Mentorship; Methods; Modality; Patient Care; Patient Recruitments; Patients; Peritoneal Dialysis; Personal Satisfaction; Policies; Policy Maker; Prospective Payment System; Provider; Quality of life; Research; Research Personnel; Risk; Science; Self Care; Societies; Techniques; Testing; Time; Training; United States; Work; burnout; care delivery; career; career development; cost; cost effective; design; econometrics; experience; financial incentive; high risk; improved; models and simulation; multidisciplinary; older patient; payment; prevent; programs; simulation; skills; social; societal costs

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.

7。项目摘要 /摘要 该K08提案旨在向MD，MD的Eugene Lin博士提供受保护的时间，培训，指导和 研究经验使他成为肾脏疾病的独立卫生服务研究者。作为 林博士是一名学术肾脏科医生，将他的研究重点放在健康政策问题和有效的护理上 与肾脏疾病有关，尤其是透析。家庭透析为患者提供独立性和 改善生活质量，对社会的成本较小。但是，许多患者选择从家切换 透析到中心透析，尤其是当他们没有得到足够的支持或不提供足够的支持时 充分准备。透析中的这种辍学是昂贵的，并且患者和社会疾病的潜在损失可能会损失 存在。最近通过末期肾脏疾病（ESRD）预期付款的透析支付改革 系统（PPS）通过使其相对于中心更有利可图，从而促进了家庭透析使用的增加 透析。但是，尚不清楚付款改革是否同时激励 更有可能辍学，或者是否导致设施的出现较少，可以支持家中的患者 透析。此外，关于减轻家庭透析辍学的潜在解决方案知之甚少。解决这个问题 知识差距，本研究的目的是：（1）量化由于ESRD PPS引起的家庭透析辍学的变化，（2） 确定提供家庭透析的设施类型的变化以及患者组成的变化 接受家庭透析，（3）评估可能减少家庭透析辍学的潜在策略， 包括再培训和喘息期。林博士将通过应用来实现这些研究目标 计量经济学技术对大量索赔数据库和通过开发患者的动态模拟模型 接受家庭透析。该建议很可能会对患者护理产生重大影响 有可能改变设施如何管理家庭透析的患者。研究付款改革的影响 还将帮助政策制定者更好地了解其效果，并有助于告知设计和完善 未来的政策旨在改善家庭透析的提供。为了实现这些目标，林博士将收到 在多学科指导的指导下，计量经济学和设计科学的其他培训 团队。拟议的工作和职业发展计划在奖励期内是现实和可行的， 将确保Lin博士发展竞争R01资金的技能。简而言之，该K08奖将提供 培训，研究经验和指导需要帮助Lin博士成功过渡到 独立卫生服务研究员。