The Role of Pretransplant Services on Outcomes and Costs in Kidney Transplantation

移植前服务对肾移植结果和成本的作用

• 批准号: 10575345
• 负责人: Xingxing Shelley Cheng
• 金额: $ 13.15万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10575345
• 关键词: Affect; Caring; Case Mixes; Chronic Kidney Failure; Clinical Investigator; Communities; Coronary Arteriosclerosis; Cost Analysis; Cost Savings; Data; Databases; Diagnostic tests; Dialysis procedure; End stage renal failure; Environment; Evaluation; Expenditure; Fee-for-Service Plans; Grant; Health; Healthcare; Hospital Costs; Hospitalization; Insurance Carriers; Insurance Coverage; Kidney; Kidney Transplantation; Laboratories; Link; Living Donors; Maintenance; Medical Surveillance; Medicare; Mentored Patient-Oriented Research Career Development Award; Methodology; Minority; Myocardial Ischemia; Nephrectomy; Organ; Outcome; Patients; Persons; Policies; Population; Practice Guidelines; Price; Privatization; Procedures; Process; Provider; Quality of Care; Reporting; Research; Rest; Role; Services; Time; Training; Transplant Recipients; Transplantation; United States; Wages; Waiting Lists; care coordination; care costs; comorbidity; cost; cost estimate; crosslink; econometrics; ethnic minority; improved; indexing; living kidney donor; mortality; payment; programs; racial minority population; screening; sex; transplant registry

Project Summary / Abstract This R03 proposal is a supplement to the K23 proposal of Dr. Xingxing S. Cheng, MD MS. The purpose of Dr. Cheng’s K23 is to refine the process of screening of coronary artery disease in patients with chronic kidney disease on the waitlist for kidney transplantation. The purpose of this R03 proposal is to examine the entirety of pretransplant services, of which coronary artery disease screening is a part, and their associations with outcomes and costs. Medicare is currently paying, at cost, over 70% of the costs of pretransplant services, including evaluation for addition to the waitlist, surveillance on the waitlist, and living donor evaluation and procurement. These costs are reported by transplant programs to Medicare in the Organ Acquisition Cost Center (OACC). The proposed research will crosslink two databases in which Dr. Cheng’s team have already demonstrated expertise at a program-year (not individual patient) level: 1) OACC cost data from the Hospital Cost Report and 2) aggregated program-year data from the Scientific Registry of Transplant Recipients (SRTR). The two aims of the proposal will be to assess the association of the quantity of pretransplant services with 1) pretransplant outcomes (quality) and 2) costs. The proposed research expands the scope of Dr. Cheng’s K23 award to the broad range of pretransplant care, and provides Dr. Cheng with the opportunity for more econometric training. The proposed research will an empirical overview of the relative distribution of costs and value among the types of pretransplant services and create a rich database of pretransplant services, outcomes, and costs at a transplant program-level. A next- step R01 grant will evaluate potential policy and practice guideline changes for pretransplant care on the basis of value. This R03 will therefore supplement the K23 award to enable Dr. Cheng to become a successful independent clinical investigator.

项目摘要 /摘要 该R03提案是Xingxing S. Cheng博士的K23提案的补充。博士的目的 Cheng的K23是完善慢性肾脏患者筛查冠状动脉疾病的过程 等待名单上的肾脏移植疾病。该R03提案的目的是检查整个 移植前服务，其中冠状动脉疾病筛查是一部分，它们与 结果和成本。 Medicare目前以费用的费用超过70％ 包括评估候补名单，对候补名单的监视以及活着的捐助者评估和 采购。这些成本由移植计划向Medicare报告的器官采集成本报告 中心（OACC）。拟议的研究将交叉链接两个数据库，郑博士的团队已经 在计划年度（而非个人患者）级别展示了专业知识：1）OACC的成本数据 成本报告和2）来自移植者科学注册表的汇总计划年度数据 （SRTR）。该提案的两个目标是评估移植前服务的数量的关联 1）结束前的结果（质量）和2）成本。 拟议的研究将Cheng博士的K23奖的范围扩展到了一系列移植前护理， 并为Cheng博士提供了进行更多经济培训的机会。拟议的研究将 经验概述成本和价值的相对分布和价值的相对分布和价值的经验概述 在移植程序级别上创建丰富的数据库，成果和成本。下一个 - 步骤R01赠款将根据移植前护理的潜在政策和实践指南更改 价值。因此，该R03将补充K23奖，以使Cheng博士成为成功 独立临床研究者。