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

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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.