Infection Control Measures in Dialysis Facilities after COVID-19: Disparities in Adoption and Impact on Hospitalization and Mortality

COVID-19 后透析设施的感染控制措施：采用差异以及对住院和死亡率的影响

• 批准号: 10193135
• 负责人: AMAL N. TRIVEDI
• 金额: $ 47.95万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10193135
• 关键词: Infection; Control; Measures; Dialysis; Facilities

PROJECT SUMMARY The COVID-19 pandemic threatens the health of patients with kidney failure because end-stage kidney disease (ESKD) is a risk factor for COVID-19 related death. Most patients with kidney failure undergo hemodialysis treatment in an outpatient dialysis facility three times a week alongside other patients. This can result in unavoidable patient clustering and an increased risk of viral transmission. Further, patients with kidney failure often have multiple comorbidities, high baseline rates of mortality, and are more likely to be black or Hispanic, racial/ethnic minority groups that have been disproportionately impacted by the pandemic. High hospitalization rates for ESKD patients also demands a health care system that allows seamless care coordination between the outpatient dialysis facilities and hospitals. In order to mitigate patients' risk of contracting COVID-19, facilities could implement several precautionary measures, including reducing the duration of each hemodialysis treatment session, assigning patients to separate facilities or shifts that specifically accommodate COVID-19 patients, establishing additional “isolation” stations within a facility, offering training and support for patients receiving home dialysis, and providing care to nursing home residents in the nursing home as opposed to an outpatient dialysis facility. Some dialysis facilities have reported implementing these strategies, but systematic national data about their adoption and association with meaningful patient outcomes are not known. Using data from the universe of all outpatient dialysis facilities and a census of patients with kidney failure undergoing dialysis for the period 2018-2022, this project has three aims. First, we estimate the extent to which COVID-19 spurred the facility-level adoption of infection-control practices, and to examine the heterogeneity in adoption across facilities. Our working hypothesis is that facilities affiliated with LDOs, those located in disadvantaged neighborhoods, and those in counties with high infection rates will be more likely to adopt protective measures in response to the threat of COVID-19. Second, we investigate the effectiveness of facility-level infection-control responses on COVID-19 related- and all-cause hospitalization and mortality. Our working hypothesis is that infection control measures resulted in a reduction of infection- related hospitalizations and mortality, but non-COVID-19 and overall hospitalization and mortality rates increased. Third, we estimate the extent to which hemodialysis sessions were impacted for dialysis patients admitted to hospitals in high-COVID-19 counties. Our working hypothesis is that dialysis patients admitted to hospitals in counties with high COVID-19 infection rates or COVID-19 “hotspots” experience greater reductions in dialysis sessions. Overall, our study will have a positive impact since dissemination of information about responses found effective will allow other facilities to adopt them, and reduce COVID-19 transmission in this vulnerable patient population.

项目摘要 2019冠状病毒病大流行威胁肾衰竭患者的健康，因为终末期肾功能衰竭患者的健康受到严重影响。 疾病（ESKD）是COVID-19相关死亡的风险因素。大多数肾衰竭患者 每周三次与其他患者一起在门诊透析机构接受血液透析治疗。这 可能导致不可避免的患者聚集和病毒传播风险增加。此外，患者 肾衰竭患者通常有多种合并症，基线死亡率高， 是黑人或西班牙裔，种族/少数民族群体，受到不成比例的影响， 流行病ESKD患者的高住院率也要求医疗保健系统， 门诊透析设施和医院之间的无缝护理协调。 为了降低患者感染COVID-19的风险，设施可以实施几项预防措施 措施，包括缩短每次血液透析治疗的持续时间， 专门容纳COVID-19患者的单独设施或班次，建立额外的 设施内的"隔离"站，为接受家庭透析的患者提供培训和支持，以及 在疗养院为疗养院居民提供护理，而不是门诊透析设施。 一些透析设施报告说实施了这些策略，但关于以下方面的系统性国家数据显示， 它们的采用和与有意义的患者结果的关联尚不清楚。 使用来自所有门诊透析设施和肾衰竭患者普查的数据 在2018 - 2022年期间进行透析，该项目有三个目标。首先，我们估计 COVID-19促使设施级采用感染控制措施，并检查 不同设施之间采用的异质性。我们的工作假设是附属于LDO的设施， 那些位于弱势社区的人，以及那些感染率高的县的人将更多 可能采取保护措施以应对COVID-19的威胁。第二，我们调查 设施级感染控制应对措施对COVID-19相关和全因住院的有效性 and mortality.我们的工作假设是感染控制措施导致了感染的减少- 相关住院和死亡率，但非COVID-19和总体住院和死亡率 增加第三，我们估计透析患者的血液透析疗程受到影响的程度 在COVID-19高发县的医院接受治疗。我们的假设是， 对于COVID-19感染率高或COVID-19 "热点"县的医院， 减少透析次数。总的来说，我们的研究将产生积极的影响，因为传播 有关有效应对措施的信息将允许其他设施采用这些措施，并减少COVID-19 在这个脆弱的患者群体中传播。