Patient Safety and Acute Kidney Injury

简介（由申请人提供）：Brown博士在达特茅斯学院获得卫生服务研究和质量改进的硕士和博士学位，师从Paul Batalden博士（硕士）和Gerald T. O'Connor博士（博士）。他目前是达特茅斯健康政策和临床实践研究所的一名成功的讲师，并致力于成为达特茅斯学院的终身助理教授，研究心血管干预中的患者安全问题。导师：Gerald T. O'Connor博士，博士，理学博士，是一位著名的流行病学家和心血管疾病和患者安全卫生服务研究员，在AHRQ K-08， AHRQ K-02， NCI K-05支持下成功指导职业发展获奖者的长期记录。Mark J. Sarnak博士，医学博士，医学硕士，是一名肾病专家和慢性肾脏疾病和衰老研究人员，有NIH资助和指导的历史。除了担任布朗博士咨询委员会的一组主要研究人员外，布朗博士的团队也在努力。O’connor和Sarnak将确保Brown博士的研究培训、项目和整体职业发展的成功。研究：在美国，经皮冠状动脉介入治疗（PCI）的患者安全是一个每年影响120多万患者的问题。对比剂诱导的急性肾损伤（CI-AKI）是国家质量论坛公认的一个重要的患者安全目标。CI-AKI是PCI后导致慢性肾脏疾病（CKD）、终末期肾脏疾病（ESRD）和死亡的并发症。一个主要的问题是缺乏预防策略的采用，对有CI-AKI风险的患者缺乏安全的造影剂剂量，以及心脏病学和肾病学之间的护理过渡。该建议的目的是：1)评估高强度质量改善是否降低CI-AKI的风险；2)评估CI-AKI是否与CKD的发生、CKD的进展、ESRD的发生、重复血运重建术和长期死亡率相关。对于具体目标1和2，我们将在新英格兰北部心血管疾病研究组的8个中心（N=32,000）前瞻性地实施高强度质量改进，收集住院结果、长期死亡率、ESRD、重复血运重建术，以及来自每个中心团队的关于成功和改进障碍的定性数据。在目的2中，我们还将使用来自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确定PCI队列（N=30,000）以及随后的肾脏并发症和死亡，研究CI-AKI问题。这两个目标都集中在提供高质量、以患者为中心的护理。在完成这一职业发展奖项后，布朗博士将拥有医疗服务研究、患者安全和质量改进方面的技能和经验，这将使他成为一名充满活力的独立研究者。

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.