Elucidating the Mechanisms of Racial and Ethnic Disparities in Dialysis Quality

（请保持文字，不要PDF） 透析是终末期肾病（ESKD）治疗的主要手段，在美国有80多万人受到影响，五年死亡率为60%，高于许多癌症和其他慢性疾病。ESKD是医疗保健中种族和民族差异最明显的例子之一。超过50%的透析患者是黑人或拉丁美洲人。一旦接受透析，黑人和拉丁美洲患者更有可能接受低质量的护理。虽然研究人员在ESKD中描述了这些差异，但文献中存在明显的差距。首先，大多数文献没有研究造成这些差异的具体机制或量化其影响。例如，虽然研究人员已经确定了邻里，供应商和个人层面的差异贡献者，研究他们的联合效果是有限的。其次，研究人员没有在区域一级广泛研究这些机制。第三，研究人员没有试图预测未来旨在改善透析差异的政策或干预措施的影响。 拟议的项目将解决这些知识差距。使用与医疗保险索赔相关的美国所有接受透析的患者的国家登记处，我们将研究导致透析护理差异的机制。目标1将评估邻里和个人一级的差异程度。这一目标的一个关键创新是在区域内和区域间对这些机制进行评价。目标2将研究一个可能缓解差距的财政激励措施的例子：向安全网提供者发放奖金。我们将使用准实验方法来评估设施失去或获得这些奖金的影响。 这项工作意义重大，因为它将告知研究人员，医疗保健提供者和政策制定者关于透析差异的机制，透析结果不成比例地差，并且独特地负担种族和少数民族。此外，我们将研究经济激励措施是否可以减轻这些负担。完成后，这些目标将指导研究人员，医疗保健提供者和政策制定者设计未来的干预措施和研究，以消除透析中的种族和民族差异。

(PLEASE KEEP IN WORD, DO NOT PDF) Dialysis, the mainstay of treatment for end-stage kidney disease (ESKD), afflicts more than 800,000 in the US and has a 60% five-year mortality rate, more than that of many cancers and other chronic illnesses. ESKD is one of the starkest examples of racial and ethnic disparities in healthcare. Over 50% of individuals on dialysis are Black or Latino. And once on dialysis, Black and Latino patients are more likely to receive low quality care. While researchers have described these disparities in ESKD, there are notable gaps in the literature. First, most of the literature has not examined specific mechanisms contributing to these disparities or quantified their effects. For instance, although researchers have identified neighborhood-, provider-, and individual-level contributors to disparities, research examining their joint effect is limited. Second, researchers have not extensively examined these mechanisms at a regional level. Third, researchers have not attempted to project the impact of future policies or interventions aimed at ameliorating disparities in dialysis. The proposed project will address these knowledge gaps. Using a national registry of all patients receiving dialysis in the US linked to Medicare claims, we will examine mechanisms that contribute to disparities in dialysis care. Aim 1 will assess the extent to which disparities occur at the neighborhood- and individual-level. A key innovation from this Aim is the evaluation of these mechanisms both within and between regional areas. Aim 2 will study an example of financial incentives that could potentially alleviate disparities: bonus payments to safety-net providers. We will use quasi-experimental methods to assess the effect of facilities losing or gaining these bonus payments. This work is significant because it will inform researchers, healthcare providers, and policymakers about mechanisms that drive disparities in dialysis, which has disproportionately poor outcomes and which uniquely burdens racial and ethnic minorities. Additionally, we will examine whether financial incentives could alleviate these burdens. When completed, these Aims will guide researchers, healthcare providers, and policymakers to design future interventions and research studies with the goal of eliminating racial and ethnic disparities in dialysis.