Outcomes and perspectives on treatment for critical limb ischemia in patients with end-stage renal disease

终末期肾病患者严重肢体缺血治疗的结果和前景

• 批准号: 10525416
• 负责人: Samir Kaushik Shah
• 金额: $ 17.44万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10525416
• 关键词: Affect; Aftercare; American; Amputation; Biology; Blood Vessels; Bypass; Cardiology; Cardiovascular system; Caring; Catheters; Clinical Research; Complement 3; Conflict (Psychology); Data; Decision Aid; Decision Making; Development; Diagnosis; Dialysis procedure; Disease; End stage renal failure; Environment; Fee-for-Service Plans; Florida; Foundations; Geography; Goals; Grant; Guidelines; Health Personnel; Health Services Research; Hemodialysis; Hospital Referrals; Incidence; Intervention; Kidney Failure; Knowledge; Leadership; Learning; Length of Stay; Life; Limb structure; Literature; Medicare; Medicare claim; Medicine; Mentors; Mentorship; Methods; Morbidity - disease rate; Nephrology; Operative Surgical Procedures; Outcome; Outcomes Research; Pain; Pain management; Patient-Centered Care; Patient-Focused Outcomes; Patients; Peripheral arterial disease; Persons; Physicians; Population; Population Heterogeneity; Positioning Attribute; Procedures; Process; Provider; Recommendation; Research; Research Personnel; Research Priority; Resources; Rest; Risk Factors; Sample Size; Selection for Treatments; Societies; Stents; Symptoms; Techniques; Training; Treatment Factor; Treatment outcome; Universities; Vascular Diseases; Writing; base; beneficiary; care outcomes; career; career development; clinical care; college; common treatment; comorbidity; critical limb Ischemia; experience; follow-up; improved; large datasets; limb loss; mortality; multidisciplinary; non-healing wounds; preference; programs; risk sharing; satisfaction; shared decision making; skill acquisition; skills; treatment as usual; treatment choice; wound care

Project Summary/Abstract Amputation and mortality rates are extraordinarily high for patients living with both advanced peripheral arterial disease, or critical limb ischemia (CLI), and end-stage renal disease (ESRD). Treatment choices for patients with CLI include catheter-based procedures (e.g. vascular stenting), surgery (e.g. bypass), primary amputation, or symptom control alone (e.g. pain management and wound care). Overall, CLI has dismal outcomes with a 25% mortality and a 30% major amputation rate at one year from diagnosis. Limited data suggest even worse outcomes for patients with ESRD – for example, approximately 50% mortality at 18 months. The existing literature on outcomes is limited by small sample sizes, short follow-up, and a focus on only two of the treatment options, catheter-based interventions and surgery. Patients with ESRD and CLI are often faced with difficult treatment decisions that are complicated by a lack of 1) robust real-world evidence on outcomes and 2) clinical care guidelines. Shared decision-making often relies on these types of information. ESRD is a life-limiting disease and treatment of CLI is resource-intensive. Nevertheless, there are no existing cardiovascular or nephrology society guidelines regarding CLI treatment in patients with ESRD. Knowledge of outcomes of CLI treatment in patients with ESRD, factors affecting CLI treatment selection, and guidelines to direct care would unequivocally improve care by helping to align patient values and preferences with treatment decisions. Owing to these gaps in knowledge, I propose a mixed methods approach using the national Medicare data 2017-2019 to understand 1) factors affecting treatment selection, and 2) traditional and patient-centered outcomes after treatment of CLI in patients with ESRD, complemented by 3) a Delphi panel of expert health care providers and patients to help inform the establishment of care guidelines and identification of research priorities. In addition to helping develop critical data on patients with ESRD and CLI, this proposal will be an essential step in my development as an independent investigator. My long-term career goals are to develop a research program focusing on outcomes of treatment and decision-making surrounding peripheral arterial disease. I hope to advance the field of vascular surgery health services research to improve patient outcomes and aid physicians and patients in aligning decision-making with patient goals and values. This proposal will immediately contribute to my short-term career objectives: increasing expertise with use of Medicare fee-for- service claims data, understanding the practice of nephrology as it applies to ESRD and comorbid conditions such as CLI, learning relevant advanced quantitative and qualitative techniques, and improving grant writing, leadership, and other career development skills. This proposal will take place in the resource-rich environment of the University of Florida College of Medicine under the guidance of an expert mentoring team.

项目摘要/摘要 患有两个晚期外周的患者的截肢和死亡率非常高 动脉疾病或临界肢体缺血（CLI）和终末期肾脏疾病（ESRD）。治疗选择 CLI患者包括基于导管的手术（例如血管支架），手术（例如旁路），主要 截肢或单独控制症状控制（例如疼痛管理和伤口护理）。总体而言，CLI很沮丧 诊断术在一年后死亡率为25％，重大截肢率为30％的结果。有限的数据 对于ESRD患者的预后甚至更糟 - 例如，18岁时死亡率约为50％ 月份。现有关于结果的文献受到小样本量，短时间的限制，重点是 只有两种治疗选择，基于附件的干预措施和手术。 ESRD和CLI患者是 通常面临困难的治疗决策，这些决策缺乏1）可靠的现实证据 结果和2）临床护理指南。共同的决策通常依赖于这些类型的信息。 ESRD是一种限制生命的疾病，CLI的治疗是资源密集的。但是，没有 有关ESRD患者CLI治疗的现有心血管或肾脏病社会指南。 了解ESRD患者CLI治疗结果的了解，影响CLI治疗选择的因素以及 直接护理的指南将通过协助患者的价值和偏好来明确地改善护理 通过治疗决定。由于知识中的这些差距，我建议使用混合方法方法 国家医疗保险数据2017-2019了解1）影响治疗选择的因素，以及2）传统和 ESRD患者的CLI治疗后，以患者为中心的结局，由3）Delphi面板完成 专家医疗保健提供者和患者，以帮助建立护理指南和身份证明 研究重点。 除了帮助开发有关ESRD和CLI患者的关键数据外，该建议还将是 作为我作为独立研究者的发展的重要步骤。我的长期职业目标是发展 研究计划的重点是围绕周围动脉的治疗和决策结果 疾病。我希望推进血管外科健康服务研究领域，以改善患者的预后 以及帮助医生和患者将决策与患者的目标和价值观保持一致。该提议将 立即为我的短期职业目标做出贡献：使用Medicare费用越来越多的专业知识 - 服务要求数据，了解适用于ESRD和合并症的肾脏病的实践 例如CLI，学习相关的高级定量和定性技术，并改善赠款写作， 领导力和其他职业发展技能。该建议将在资源丰富的环境中进行 在佛罗里达大学医学院的专家指导团队的指导下。