Impact of the ESRD Treatment Choices Model on Home Dialysis Uptake and Disparities

ESRD 治疗选择模型对家庭透析接受率和差异的影响

• 批准号: 10525495
• 负责人: Sri Lekha Tummalapalli
• 金额: $ 15.39万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 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/10525495
• 关键词: Impact; ESRD; Treatment; Choices; Model

PROJECT SUMMARY/ABSTRACT Dr. Sri Lekha Tummalapalli is a nephrologist and health services researcher whose long-term goal is to become a leading national expert studying healthcare policies and delivery system interventions to optimize the quality and equity of care for patients with kidney disease. If awarded, this K08 mentored career development award will provide Dr. Tummalapalli with the necessary protected time and training to develop into an independent physician-investigator. Dr. Tummalapalli will be mentored primarily by Dr. Lawrence Casalino, the Livingston Farrand Professor of Population Health Sciences and an expert in alternative payment models and the organization of the healthcare delivery system. Under the guidance of a multidisciplinary mentorship team, Dr. Tummalapalli will engage in a rigorous training and career development plan in the following 3 areas: (1) qualitative research for evaluating healthcare delivery systems (Dr. Lawrence Casalino), (2) quasi-experimental research designs (Dr. Yuhua Bao) and advanced epidemiologic methods (Dr. Michelle Estrella), and (3) the use of large claims databases to examine quality and equity of care (Dr. Sumit Mohan, Dr. Said Ibrahim). Dr. Tummalapalli will conduct her research and training in the outstanding environment of Weill Cornell Medicine’s Department of Population Health Sciences, surrounded by internationally recognized experts in health services research, health economics, epidemiology, and biostatistics. End-stage renal disease (ESRD) requiring dialysis causes an enormous clinical and economic burden, affecting over 550,000 Americans and costing ~$49 billion annually. Home dialysis is a preferred treatment for ESRD, offering better quality of life than in-center hemodialysis at reduced cost. Yet, uptake of home dialysis is low and there are stark racial/ethnic and socioeconomic disparities in uptake. There is limited understanding of organizational structures and processes that lead to higher home dialysis uptake and reduced disparities. This proposal applies rigorous health services research techniques to examine the ESRD Treatment Choices (ETC) Model, a randomized alternative payment model that incentivizes home dialysis uptake. Leveraging qualitative interviews and national large claims databases, this research aims to (1) Identify changes in structures and processes of care in response to the ETC Model; (2) Identify facility and practice structures and processes of care associated with home dialysis uptake; and (3) Assess the impact of the ETC Model on socioeconomic and racial/ethnic disparities in home dialysis uptake. The knowledge gained in this project is highly likely to influence healthcare policy and the delivery of kidney disease care on the national scale by revealing effective structures of care, processes of care, and policy levers that increase home dialysis uptake and reduce disparities. This work will equip Dr. Tummalapalli with the skills and research experience to become one of the few independent physician-investigators studying nephrology payment and delivery system reform.

项目概要/摘要 Sri Lekha Tummalapalli 博士是一位肾脏病学家和卫生服务研究员，其长期目标是 成为研究医疗保健政策和交付系统干预措施以优化的领先国家专家 肾病患者护理的质量和公平性。如果获奖，这位 K08 指导的职业生涯 发展奖将为 Tummalapalli 博士提供必要的受保护时间和培训来发展 成为一名独立的医师研究员。 Tummalapalli 博士将主要由 Lawrence 博士指导 卡萨利诺（Casalino），利文斯顿·法兰德人口健康科学教授，替代支付专家 医疗保健提供系统的模型和组织。在多学科的指导下 Tummalapalli 博士将在导师团队中接受严格的培训和职业发展计划 以下 3 个领域：(1) 评估医疗保健服务系统的定性研究（Lawrence Casalino 博士）， (2) 准实验研究设计（鲍玉华博士）和先进的流行病学方法（米歇尔博士） Estrella），以及（3）使用大型索赔数据库来检查护理的质量和公平性（Sumit Mohan 博士， 赛义德·易卜拉欣博士）。 Tummalapalli博士将在优良的环境中进行研究和培训 威尔康奈尔医学院人口健康科学系周围环绕着国际公认的 卫生服务研究、卫生经济学、流行病学和生物统计学方面的专家。 需要透析的终末期肾病（ESRD）会造成巨大的临床和经济负担， 影响超过 55 万美国人，每年损失约 490 亿美元。家庭透析是首选治疗方法 ESRD，以更低的成本提供比中心血液透析更好的生活质量。然而，家庭透析的普及率 低，并且在接受方面存在明显的种族/族裔和社会经济差异。人们的了解还有限 提高家庭透析使用率并减少差异的组织结构和流程。这 提案应用严格的卫生服务研究技术来检查 ESRD 治疗选择 (ETC) 模型，一种随机替代支付模型，可激励家庭透析的采用。利用质量 通过访谈和国家大型理赔数据库，本研究旨在 (1) 识别结构和理赔的变化 响应 ETC 模型的护理流程； (2) 确定设施和实践结构及流程 与家庭透析相关的护理； (3) 评估 ETC 模式对社会经济和社会的影响 家庭透析接受方面的种族/民族差异。在这个项目中获得的知识很可能 通过揭示有效的信息来影响全国范围内的医疗保健政策和肾脏疾病护理的提供 提高家庭透析采用率并减少透析的护理结构、护理流程和政策杠杆 差异。这项工作将使 Tummalapalli 博士具备技能和研究经验，成为一名 很少有独立医生研究者研究肾脏病支付和交付系统改革。