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.

项目总结/摘要 本R 03方案是对S星星博士K23方案的补充。郑博士，MD MS。 Cheng的K23是为了完善慢性肾脏病患者冠状动脉疾病筛查的过程 在等待肾脏移植的名单上。本R 03提案的目的是审查 冠状动脉疾病筛查是移植前服务的一部分， 成果和成本。医疗保险目前按成本支付移植前服务费用的70%以上， 包括评估是否添加到等待名单，对等待名单的监督，以及活体捐赠者评估， 采购等这些费用由移植项目在器官获取费用中向医疗保险报告 中心（OACC）。拟议中的研究将交叉两个数据库，其中郑博士的团队已经 在项目年（非个体患者）水平上证明的专业知识：1）来自医院的OACC成本数据 成本报告和2）来自移植接受者科学登记处的汇总计划年数据 （SRTR）。该提案的两个目的是评估移植前服务数量之间的关联 1）移植前结果（质量）和2）成本。 拟议中的研究将郑博士的K23奖的范围扩大到广泛的移植前护理， 并为郑博士提供更多的计量经济学培训机会。拟议的研究将 移植前服务类型之间的成本和价值相对分布的实证概述， 建立一个丰富的移植前服务数据库，结果，并在移植计划水平的成本。下一个- 步骤R 01赠款将评估潜在的政策和实践指南的变化，移植前护理的基础上， 有价值。因此，R 03将补充K23奖，使郑博士成为一个成功的 独立临床研究者。