Improving Quality and Access to Early Steps in Kidney Transplantation

提高肾移植早期步骤的质量和可及性

• 批准号: 10188523
• 负责人: Stephen Pastan
• 金额: $ 65.68万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-16 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10188523
• 关键词: Address; Adult; Advocacy; African American; Characteristics; Clinical; Communities; Complex; Data; Data Collection; Dialysis procedure; End stage renal failure; Epidemiology; Evaluation; Female; Focus Groups; Funding; Future; Geographic Locations; Geography; Goals; Guidelines; Health system; Hospitalization; Improve Access; Intervention; Investigation; Kidney Transplantation; Link; Medical; Methods; Modeling; Needs Assessment; Neighborhood Health Center; Neighborhoods; North Carolina; Ohio; Outcome; Patients; Pattern; Population; Population Characteristics; Population Heterogeneity; Population Research; Process; Provider; Quality of life; Registries; Research Methodology; Rivers; South Carolina; Southeastern United States; Surveys; Time; Transplantation; United States Centers for Medicare and Medicaid Services; Variant; Waiting Lists; Work; disparity reduction; effective intervention; health care delivery; improved; low socioeconomic status; multi-component intervention; multilevel analysis; national surveillance; novel; racial disparity; randomized trial; relative cost; surveillance data; transplant centers

Abstract Kidney transplantation offers longer survival, better quality of life, reduced hospitalization, and lower cost relative to dialysis for the >500,000 end-stage renal disease (ESRD) patients on dialysis in the US. Despite this evidence, only 18.5% of ESRD patients are waitlisted for a kidney transplant. Extensive population research has identified substantial variability in kidney transplant access among US ESRD patients as well as dialysis facilities and transplant centers due to patient-, neighborhood- and health system-level factors, but no national surveillance data exist on early kidney transplant steps. Our overarching, long-term goal is to eliminate inequities and improve healthcare delivery for ESRD patients in every step of the highly complex kidney transplant process. Our specific aims are to: (1) describe dialysis facility and transplant center differences in early steps of the kidney transplantation process, including a) referral for kidney transplant evaluation, b) start of the transplant evaluation process, and c) placement on the national deceased donor waiting list and (2) determine the patient-, neighborhood-, and health center-level barriers that explain disparities in these early steps of kidney transplantation among participating ESRD Networks in the Southeast US, Northeast US, and Ohio River Valley, and determine how barriers vary across geographic region. This study will be conducted in a geographically diverse population of ESRD patients in the Southeast (GA, NC, SC), Northeast (CT, MA, ME, NH, NY, RI, VT) and the Ohio River Valley (IN, KY, OH) representing 48 transplant centers, ~1,800 dialysis facilities, and ~155,000 incident ESRD patients. With these novel data, we will conduct critical epidemiologic analyses to describe regional variability in several outcomes, including: a) dialysis facility-level kidney transplant referral rates, b) dialysis facility-level evaluation start rates, and c) transplant center waitlisting rates among those who initiated the evaluation process. In Aim 2, we will identify the barriers to these important transplant steps using multilevel models as well as dialysis facility and transplant center provider surveys and patient focus groups. This work will help to identify the geographic regions and the dialysis facilities with the lowest rates of kidney transplant referral and evaluation and better understand the characteristics of the populations with lowest rates of transplantation access. Findings will be disseminated to the respective ESRD Network leaders in each geographic region as well as to transplant centers and other stakeholders, where they can target regional quality improvement efforts to improve access and reduce disparities in kidney transplantation. Results will also inform future multi-level and multicomponent interventions adapted to fit the needs of each geographic region.

抽象的 肾移植可延长生存期、提高生活质量、减少住院时间并降低费用 相对于美国超过 500,000 名接受透析的终末期肾病 (ESRD) 患者的透析。尽管 根据这一证据，只有 18.5% 的 ESRD 患者被列入肾移植的候补名单。人口众多 研究发现美国 ESRD 患者的肾移植获取存在显着差异 由于患者、社区和卫生系统层面的因素，透析设施和移植中心的数量有所减少，但没有 存在早期肾移植步骤的国家监测数据。我们的总体长期目标是消除 不平等并改善终末期肾病患者在高度复杂的肾脏的每一步的医疗服务 移植过程。我们的具体目标是：(1) 描述透析设施和移植中心在以下方面的差异： 肾移植过程的早期步骤，包括 a) 转介肾移植评估，b) 开始 移植评估过程，以及 c) 列入国家已故捐赠者等待名单以及 (2) 确定患者、社区和健康中心层面的障碍，这些障碍可以解释这些早期的差异 美国东南部、美国东北部和美国参与 ESRD 网络的肾移植步骤 俄亥俄河流域，并确定不同地理区域的障碍如何变化。 这项研究将在东南部（乔治亚州、乔治亚州、 北卡罗来纳州、南卡罗来纳州）、东北部（康涅狄格州、马萨诸塞州、缅因州、新罕布什尔州、纽约州、罗德岛州、佛蒙特州）和俄亥俄河谷（印第安纳州、肯塔基州、俄亥俄州）代表 48 移植中心、约 1,800 个透析设施和约 155,000 名 ESRD 患者。有了这些新颖的数据，我们 将进行关键的流行病学分析，以描述多种结果的区域差异，包括：a) 透析设施级肾移植转诊率，b) 透析设施级评估启动率，以及 c) 启动评估过程的移植中心等候名单率。在目标 2 中，我们将确定 使用多级模型以及透析设施进行这些重要移植步骤的障碍和 移植中心提供者调查和患者焦点小组。这项工作将有助于确定地理 肾移植转诊和评估率最低且较好的地区和透析设施 了解移植机会率最低的人群的特征。调查结果将是 分发给各个地理区域的 ESRD 网络领导者并进行移植 中心和其他利益相关者，他们可以针对区域质量改进努力，以改善获取机会 并减少肾移植方面的差异。结果还将为未来的多层次和多成分提供信息 采取适应每个地理区域需求的干预措施。