Patient Safety and Acute Kidney Injury

描述（由申请人提供）：布朗博士在达特茅斯学院获得了卫生服务研究和质量改进的硕士和博士学位，并得到了保罗·巴塔尔登博士（硕士）和杰拉尔德·T.奥康纳博士。他目前是达特茅斯卫生政策和临床实践研究所的一名成功讲师，并承诺将晋升为达特茅斯的终身助理教授，致力于心血管干预中的患者安全问题。导师：Gerald T.奥康纳，博士，ScD，是一个著名的流行病学家和心血管疾病和病人安全的健康服务研究员，成功地指导职业发展获奖者与AHRQ K-08，AHRQ K-02，NCI K-05支持的长期记录。Dr. Mark J. Sarnak，MD，MS是一位肾脏病专家和慢性肾脏病和衰老研究人员，有NIH资助和指导的历史。沿着的主要研究人员团队作为布朗博士的咨询委员会，奥康纳博士和Sarnak将确保布朗博士的研究培训，项目和整体职业发展的成功。研究人员：经皮冠状动脉介入治疗（PCI）中的患者安全是一个问题，在美国每年影响超过120万患者。造影剂诱导的急性肾损伤（CI-AKI）被认为是国家质量论坛的重要患者安全目标。CI-AKI是导致慢性肾病（CKD）、终末期肾病（ESRD）和PCI后死亡的并发症。一个主要的问题是缺乏预防策略的采用，对有CI-AKI风险的患者的造影剂的安全剂量，以及心脏病学和肾脏病学之间的护理过渡。该提案的目的是：1）评价高强度质量改善是否降低了CI-AKI的风险; 2）评价CI-AKI是否与CKD的发生、CKD的进展、ESRD的发生、重复血运重建和长期死亡率相关。对于具体目标1和2，我们将在北方新英格兰心血管疾病研究组（N= 32，000）的8家中心前瞻性实施高强度质量改善，收集院内结局、长期死亡率、ESRD、重复血运重建以及每个中心团队的成功和改善障碍的定性数据。对于目标2，我们还将使用退伍军人健康管理局的管理数据，通过利用2003-2007年的患者治疗文件和实验室文件来研究CI-AKI问题，以确定PCI队列（N= 30，000）和随后的肾脏并发症和死亡。这两个目标都集中在提供高质量，以病人为中心的护理。在这个职业发展奖完成后，布朗博士将拥有在卫生服务研究，病人安全和质量改进方面的技能和经验，这将使他能够成功地成为一个充满活力的独立调查员。 公共卫生相关性：在美国，每年进行超过两百万例心脏手术;这些手术使用造影剂进行成像，直接损伤或严重损害患者的肾脏。因此，每年有超过200，000名患者因造影剂而发生肾损伤，导致透析和死亡。我们将与来自不同学科的临床医生合作，以提高患者的安全性，防止肾损伤，并确定可能被修改以降低器官损伤风险的早期风险因素。

DESCRIPTION (provided by the applicant): Dr. Brown received his MS and PhD from Dartmouth College in health services research and quality improvement, under the mentorship of Dr. Paul Batalden (masters) and Dr. Gerald T. O'Connor (doctorate). He is currently a successful instructor at The Dartmouth Institute for Health Policy and Clinical Practice with a commitment to be advanced to a tenure-track assistant professor at Dartmouth working on patient safety issues in cardiovascular interventions. MENTORS: Dr. Gerald T. O'Connor, PhD, ScD, is a renowned epidemiologist and health services researcher in cardiovascular disease and patient safety with a long track record of successfully mentoring career development awardees with AHRQ K-08, AHRQ K-02, NCI K-05 support. Dr. Mark J. Sarnak, MD, MS is an expert nephrologist and researcher in chronic kidney disease and aging with a history of NIH funding and mentoring. Along with a team of leading researchers serving as Dr. Brown's advisory committee, Drs. O'Connor and Sarnak will ensure the success of Dr. Brown's research training, project, and overall career development. RESEARCH: Patient safety in percutaneous coronary interventions (PCI) is a problem that affects over 1.2 million patients each year in the United States. Contrast-induced acute kidney injury (CI-AKI) is recognized as an important patient safety objective for the National Quality Forum. CI-AKI is a complication leading to chronic kidney disease (CKD), end-stage renal disease (ESRD), and death following PCI. A major problem is the lack of adoption of prophylactic strategies, safe dosing of contrast for patients at risk of CI-AKI, and transition of care between cardiology and nephrology. The aims of the proposal are: 1) to evaluate whether high-intensity quality improvement reduces the risk of CI-AKI; and 2) to evaluate whether CI-AKI is associated with the development of CKD, progression of CKD, development of ESRD, repeat-revascularization, and long-term mortality. For specific aims 1 and 2 we will prospectively implement high-intensity quality improvement at 8 centers in the Northern New England Cardiovascular Disease Study Group (N=32,000), collect in-hospital outcomes, long-term mortality, ESRD, repeat revascularizations, and qualitative data on success and barriers to improvement from teams at each center. For Aim 2 we will also investigate the problem of CI-AKI using administrative data from the Veterans Health Administration by utilizing the patient treatment files and laboratory files from 2003-2007 to identify a PCI cohort (N=30,000) and subsequent renal complications and death. Both aims are focused on providing high quality, patient-centered care. At the completion of this career development award, Dr. Brown will have the skills and experience in health services research, patient safety, and quality improvement that will enable him to succeed as a dynamic independent investigator. PUBLIC HEALTH RELEVANCE: Over two million cardiac procedures are performed each year in the United States; these procedures use contrast dye for imaging purposes, which directly injures or severely impairs the patient's kidneys. As a result, over 200,000 patients each year develop kidney injury from the contrast dye, resulting in dialysis and death. We will work with clinicians from different disciplines to improve patient safety, protect against kidney injury, and identifying early risk factors that may be modified to reduce the risk of organ injury.