Elucidating the Mechanisms of Racial and Ethnic Disparities in Dialysis Quality

阐明透析质量中种族和民族差异的机制

基本信息

批准号：
10720662
负责人：
Eugene Lin
金额：
$ 41.38万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10720662
关键词：
Address Affect Alaska Native American Indians Area Black Populations Black race Breast Caring Chronic Disease Colorectal Conceptions County Dialysis procedure Disparity End stage renal failure Equity Ethnic Origin Evaluation Fee-for-Service Plans Future Goals Health Personnel Health Service Area Home Hospital Referrals Hospitalization Individual Intervention Intervention Studies Joints Kidney Kidney Transplantation Knowledge Latino Link Literature Malignant Neoplasms Malignant neoplasm of prostate Marketing Measures Medicare Medicare claim Methods Modality Morbidity - disease rate Myocardial Infarction Native Hawaiian or Other Pacific Islander Neighborhoods Outcome Patients Policies Policy Maker Provider Publishing Quality of Care Quasi-experiment Race Registries Research Research Personnel Resources Selection Bias Testing Work design disparity reduction ethnic difference ethnic disparity ethnic health disparity ethnic minority financial incentive health care disparity health disparity hospital services improved improved outcome innovation mortality payment racial difference racial disparity racial minority research study safety net stem therapy design underserved area underserved minority

项目摘要

(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.

（请保持言语，不要PDF）透析是终末期肾脏疾病（ESKD）治疗的主要治疗方法，在美国折磨了80万以上，五年死亡率超过60％，比许多癌症和其他慢性病的死亡率高。 ESKD是医疗保健中种族和种族差异的最严重的例子之一。超过50％的透析个体是黑人或拉丁裔。一旦透析，黑人和拉丁裔患者更有可能接受低质量的护理。尽管研究人员描述了ESKD中的这些差异，但文献中存在显着差距。首先，大多数文献尚未检查导致这些差异或量化其影响的特定机制。例如，尽管研究人员已经确定了差异的邻里，提供者和个人级别的贡献者，但研究其关节效应的研究是有限的。其次，研究人员尚未在区域层面进行广泛检查这些机制。第三，研究人员尚未尝试预测旨在改善透析差异的未来政策或干预措施的影响。拟议的项目将解决这些知识差距。我们使用在美国接受透析的所有患者的国家注册表与Medicare主张有关，我们将研究有助于透析护理差异的机制。 AIM 1将评估邻里和个人级别发生差异的程度。该目标的关键创新是对区域内部和区域之间这些机制的评估。 AIM 2将研究一个可能减轻差距的经济激励措施的示例：向安全网提供者付款。我们将使用准实验方法来评估损失或获得这些奖金付款的设施的影响。这项工作很重要，因为它将为研究人员，医疗保健提供者和政策制定者提供有关透析差异的机制，这些机制的结果较差，而且种族和少数族裔都具有独特的负担。此外，我们将研究财务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，医疗保健提供者和决策者设计未来的干预措施和研究，以消除透析中的种族和种族差异。