Veteran Access and Limitations to Organ Recovery (VALOR)

退伍军人器官恢复的机会和限制 (VALOR)

• 批准号: 10833392
• 负责人: Raymond J Lynch
• 金额: $ 66.14万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-10 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10833392
• 关键词: Adherence; Advocacy; Age; American; Area; Authorization documentation; Automated Clinical Decision Support; Awareness; Beds; Caring; Case Study; Cessation of life; Chronic; Clinical; Complex; Consensus; Continuity of Patient Care; Contractor; Data; Dedications; Disparity; Disparity population; Elderly; Electronic Health Record; Environment; Evaluation; Failure; Family; Federal Government; Funding; Gifts; Grant; Health; Health system; Healthcare; Hospital Administration; Hospitals; Human Resources; Inequity; Institution; Intervention; Interview; Kidney; Laboratories; Laws; Life; Liver; Logic; Maps; Measures; Medical; Medical center; Medicine; Minority; Modeling; Monitor; National origin; Operative Surgical Procedures; Organ; Organ Donations; Organ Donor; Organ Procurements; Organ Transplantation; Organ failure; Organization and Administration; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Perception; Performance; Physicians; Physiological; Population; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Process; Provider; Quality of Care; Race; Recovery; Research; Risk Factors; Role; Rural; Sampling; Source; Standardization; Structure; Support System; Surveys; System; Transplantation; Underserved Population; United States; United States Department of Veterans Affairs; Veterans; Vulnerable Populations; Waiting Lists; access disparities; authority; biomedical referral center; body system; care coordination; clinical decision support; cost; critical care nursing; disability; ethnic minority; experience; follow-up; health practice; improved; interest; marginalized population; meetings; military veteran; minority patient; older patient; organ procurement transplantation network; patient advocacy group; patient oriented; patient population; process improvement; programs; prospective; racial minority; radiological imaging; response; rural area; screening; sociodemographics; support tools; symposium; virtual

Abstract: Deceased donors provide lifesaving gifts to patients with chronic organ failure. Organ donation occupies a unique position in American healthcare, as donation care is provided without cost to the patient or their family and is mandated to be provided without bias to age, disability, race, or national origin by federal contractors known as organ procurement organizations (OPOs). Previous regulatory measures of OPO performance did not allow adequate objectivity, reliability, and transparency into procurement practice and have been replaced by a new metric introduced by this study's authors. Analyses using this metric reveal that older persons, minorities, and those living in poor, rural, and remote areas receive lesser access to organ donation. Veterans Administration Medical Centers (VAMCs) represent the largest single hospital system in the United States, and serve a population recognized to be underserved in many aspects of health and medicine. We have developed preliminary data showing that VAMCs recover deceased donor organs at a rate of 4% that of non-VA hospitals. The basis for this disparity is unclear, but given the high concentration of vulnerable and underserved groups at VAMCs, there is a strong imperative to improve donation access for these patients. In this proposal, we will leverage VAMCs' unparalleled electronic health records (EHRs), which offer detailed information on longitudinal patient care and outcomes, to enumerate the potential supply of organ donors nationwide over a 10-year historical period. We will use physiologic, laboratory, and radiographic data to define potential donor quality and estimate transplant yields at varying levels of donation performance relative to non-VA hospitals. We will also interview patients, critical care nurses and physicians at VAMCs, and OPO personnel to gather their experiences and perceptions regarding barriers to more effective donor recovery from these institutions. We will use findings from these qualitative and VA EHR studies to inform a consensus conference on best practices for improved organ donation care at VAMCs in year 2 of our project. Based on the findings of the first two aims in this study, we will create a model for improved VAMC donation care using a large, nationally-representative sample of VAMCs and their attendant OPOs. We will introduce a clinical decision support tool into VA EHR to maximize referral of potential donors. Study staff will integrate with OPOs in responding to VAMC referrals, utilizing VA EHR sources to assist in evaluating patients for donation. Study coordinators will facilitate workflow between VAMC and OPO staff, supporting and monitoring adherence to best practices defined in the consensus conference. We will conduct a follow-up stakeholder meeting to assess perceptions of the pilot program's efficacy among VAMC providers, OPO staff, and veteran and patient advocacy groups from within the study area. Together, this study's findings will not only help to ameliorate disparities in veterans' access to donation care, but will inform efforts to standardize and improve donation care among other underserved populations.

摘要：已故捐献者为慢性器官衰竭患者提供救命礼物。器官捐献 在美国医疗保健中占有独特的地位，因为捐赠性护理是免费提供给患者或 他们的家庭，并被要求由联邦政府提供没有年龄、残疾、种族或民族血统的偏见 被称为器官采购组织(OPO)的承包商。此前对OPO的监管措施 业绩不能使采购实践具有足够的客观性、可靠性和透明度，而且 已经被这项研究的作者引入的新指标所取代。使用这一指标的分析表明， 老年人、少数民族以及生活在贫困、农村和偏远地区的人获得器官的机会较少 捐款。退伍军人管理局医疗中心(VAMCs)是世界上最大的单一医院系统 在美国，并为公认在健康和医学方面服务不足的人群提供服务。 我们开发的初步数据显示，VAMC以4%的速度恢复死亡的供体器官 非退伍军人医院。造成这种差异的基础尚不清楚，但考虑到弱势群体和 在VAMC服务不足的群体中，迫切需要改善这些患者的捐赠机会。 在本计划中，我们将利用VAMC无与伦比的电子健康记录(EHR)，它可提供 关于纵向病人护理和结果的详细信息，以列举潜在的器官供应 在10年的历史时期内，向全国范围内的捐助者提供援助。我们将使用生理学、实验室和放射学数据 确定潜在的捐赠者质量并估计不同捐献水平下的移植产量 相对于非退伍军人医院。我们还将采访VAMCS的患者、重症护理护士和医生，以及 OPO人员收集他们对更有效捐赠者障碍的经验和看法 从这些机构恢复过来。我们将使用这些定性和VA EHR研究的结果来向 在我们项目的第二年，关于改善VAMC器官捐赠护理的最佳实践的共识会议。 基于本研究中前两个目标的发现，我们将创建一个改进的VAMC模型 使用具有全国代表性的VAMC及其随行OPO的大样本进行捐赠护理。我们会 将临床决策支持工具引入VA EHR，以最大限度地提高潜在捐赠者的转介能力。研究人员将 与OPO整合，响应VAMC转诊，利用VA EHR资源协助评估患者 用于捐赠。研究协调员将促进VAMC和OPO工作人员之间的工作流程，支持和 监测对协商一致会议确定的最佳做法的遵守情况。我们将进行后续跟进 召开利益相关者会议，评估VAMC提供商、OPO工作人员、 以及来自研究区域内的退伍军人和患者倡导团体。 总而言之，这项研究的发现不仅有助于改善退伍军人获得捐赠方面的差距 这将有助于标准化和改善其他未得到充分服务的人群中的捐赠护理。

项目成果

What is visible is fixable: Visual dashboards for multi-domain assessment of organ procurement organization performance.

可见的东西是可以修复的：用于器官采购组织绩效多领域评估的可视化仪表板。

• DOI: 10.1016/j.ajt.2023.08.020
• 发表时间: 2023
• 期刊: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
• 作者: Doby,BriannaL;Casey,Kylie;Ross-Driscoll,Katie;RahmanOvi,Musaddiqur;HossainBhuiyea,MdShabbir;Isty,IstiakAhmed;Lynch,RaymondJ
• 通讯作者: Lynch,RaymondJ

Opportunity to increase deceased donation for United States veterans.

有机会增加对美国退伍军人的已故捐款。

• DOI: 10.1111/ajt.16773
• 发表时间: 2021
• 期刊: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
• 作者: Doby,BriannaL;Brockmeier,Diane;Lee,KevinJ;Jasien,Christine;Gallini,Julia;Cui,Xiangqin;Zhang,RebeccaH;Karp,SethJ;Marklin,Gary;Lynch,RaymondJ
• 通讯作者: Lynch,RaymondJ