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：已故捐赠者为慢性器官衰竭患者提供了拯救生命的礼物。器官捐献

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