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

项目摘要/摘要 斯里·勒卡·图马拉帕利博士是一名肾病学家和卫生服务研究员，他的长期目标是 成为研究医疗保健政策和提供系统干预的领先国家专家，以优化 肾脏疾病患者的护理质量和公平性。如果获奖，这位K08指导了职业生涯 发展奖将为图马拉帕利博士提供必要的保护时间和培训，以发展 成为一名独立的医生兼调查员。图马拉帕利博士将主要由劳伦斯博士指导 卡萨利诺，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 导师团队，Tummarapalli博士将参与严格的培训和职业发展计划 以下3个领域：(1)评估医疗保健提供系统的定性研究(Lawrence Casalino博士)， (2)准实验研究设计(包玉华博士)和先进流行病学方法(米歇尔博士 以及(3)使用大型索赔数据库来检查护理质量和公平性(Sumit Mohan博士， 赛义德·易卜拉欣博士)。Tummarapalli博士将在卓越的环境中进行研究和培训 威尔·康奈尔医学部人口健康科学部，周围是国际公认的 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。 终末期肾病(ESRD)需要透析，造成巨大的临床和经济负担， 每年影响超过55万美国人，造成约490亿美元的损失。家庭透析是一种首选的治疗方法 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，家庭透析的普及是 低，而且在吸纳方面存在明显的种族/族裔和社会经济差异。人们对……的了解有限 组织结构和流程导致更高的家庭透析摄取率和减少差距。这 提案应用严格的卫生服务研究技术来审查ESRD治疗选择(ETC) 模型，一种随机的替代支付模式，激励家庭透析吸收。利用质量 访谈和国家大型索赔数据库，这项研究的目的是(1)确定结构和 响应ETC模式的护理过程；(2)确定设施和实践结构和过程 与家庭透析摄取相关的护理；以及(3)评估ETC模式对社会经济和 家庭透析吸收方面的种族/民族差异。从这个项目中获得的知识极有可能 通过披露有效的信息，在全国范围内影响医疗保健政策和肾脏疾病护理的提供 增加家庭透析吸收和减少的护理结构、护理过程和政策杠杆 差距。这项工作将使图马拉帕利博士拥有技能和研究经验，成为 很少有独立的医生和研究人员研究肾脏病的支付和递送系统改革。

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.