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Contextual Predictors of Hospitalization and Quality of Life among Patients on Hemodialysis

血液透析患者住院和生活质量的背景预测因素

基本信息

批准号：
10293571
负责人：
Kathryn Taylor
金额：
$ 4.49万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-01-21 至 2022-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10293571
关键词：
Address Adult Affect Age Caring Case-Control Studies Chronic Kidney Failure Cohort Studies Communities Complex Cross-Sectional Studies Development Dialysis procedure Disease Progression Drug abuse Education End stage renal failure Enrollment Ethnic Origin Exposure to Financial Hardship Gender General Population Goals Health Health Care Costs Health behavior change Hemodialysis Homelessness Hospitalization Income Infection Intervention Legal Measures Medical Records National Institute of Nursing Research Nursing Research Occupations Outcome Participant Patient-Focused Outcomes Patients Persons Population Prospective Studies Prospective cohort Provider Quality of life Race Reduce health disparities Reporting Research Research Personnel Risk Risk Factors Sampling Self Management Socioeconomic Status Subgroup Testing Time Treatment Protocols United States Woman World Health Organization base black men chronic pain cocaine use comorbidity design experience federal poverty level food insecurity gender difference health care service utilization health disparity heroin use high risk hospitalization rates housing instability implicit bias improved income disparities large datasets male modifiable risk mortality multiple chronic conditions opioid use disorder patient oriented patient subsets poor communities prescription opioid programs racial difference racial disparity social social health determinants substance use tertiary prevention

项目摘要

Project Summary Over 700,000 people in the United States have end-stage kidney disease (ESKD). This number has increased by approximately 20,000 each year for over 2 decades. Some subgroups are more likely than others to progress from chronic kidney disease to ESKD. In addition to established racial and income disparities in chronic kidney disease progression, people engaging in high-risk substance use (i.e. with a high likelihood of health, legal, social, or financial consequences) or experiencing food insecurity or housing instability are also at increased risk. Despite their relevance in chronic kidney disease progression, we do not know the extent to which these risk factors affect patient outcomes after initiation of hemodialysis or which subgroups among patients on hemodialysis are affected by them. This is significant because patients on hemodialysis exposed to these modifiable risk factors may be particularly vulnerable to poor outcomes and high-cost healthcare utilization. The proposed study leverages the World Health Organization’s Commission on the Social Determinants of Health framework to generate two testable hypotheses: (1) High-risk substance use, food insecurity and housing instability will cluster within patient subgroups stratified by indicators of socioeconomic position; (2) this “risk factor clustering” will increase risk of hospitalization and decrease quality of life among patients on hemodialysis. Accordingly, the two specific aims of the study are to determine associations between indicators of socioeconomic position and high-risk substance use, food insecurity, and housing instability among patients on hemodialysis; and to examine the independent associations of substance use, food insecurity and housing instability with hospitalization and quality of life. The research team will enroll a convenience sample of 330 participants from the same large dialysis organization. For Aim 1, participants will complete measures of independent (age, gender, race, ethnicity, education, income and financial strain, occupation and community poverty) and dependent variables (substance use, food insecurity and housing instability), enabling cross- sectional analyses. For Aim 2, the study team will leverage a prospective cohort design to quantify associations between substance use, food insecurity, housing instability and hospitalization rate. We will follow participants for 6 months and extract hospitalization counts from dialysis facility medical records. Participants will also complete a measure of quality of life at enrollment. We will examine cross-sectional associations between substance use, food insecurity, housing instability and quality of life. The proposed study advances the National Institute of Nursing Research’s strategic goal to support self-management and improve quality of life for patients with multiple chronic conditions. Patients with ESKD self-manage highly complex treatment regimens and have multiple comorbidities. The proposed study will enhance current approaches to support self-management and tertiary prevention of ESKD sequelae by demonstrating the relevance of social determinants of health within existing health behavior change or quality improvement conceptual frameworks. 1

项目总结