OVERCOMING BARRIERS TO ADEQUATE DELIVERY OF HEMODIALYSIS

描述(改编自申请者的摘要)：三分之一的美国人 血液透析患者的透析量不足。这 对透析患者死亡率的贡献是 工业化国家以每年23%的速度增长。透析不足可能也是 导致高昂的费用，包括平均两次住院 每年每个患者和医疗保险总支出为100亿美元/年。 他们之前的工作确定了四个可能是最重要的因素 充分透析的重要障碍(患者不依从性、低透析率 处方、导管使用和凝血)，并记录不足 患者与提供者的沟通与患者对透析的理解 充分性。 这项建议的社区随机对照试验延长了他们的 之前的工作是针对这些特定的障碍，通过 量身定做的反馈和沟通干预。三十次透析 俄亥俄州东北部的设施将被随机分配到干预和 对照组，120例接受不充分透析的患者 来自15个干预组和对照组，120名患者接受 从15个干预机构登记的透析不足，从15个干预机构登记的120人 控制设施。基线评估将包括透析措施 六个月的分娩、特定障碍和住院费用 追溯间隔时间。干预患者和他们的医生以及 护士将收到关于透析充分性和克服的量身定做的反馈 特定于患者的障碍。然后，他们将开会制定护理计划 解决这些障碍。还将提供每两个月一次的进度报告 对干预患者和提供者进行为期六个月的随访期。 主要分析将比较透析充分性和 干预患者与对照组患者的住院相关成本 对设施内患者的嵌套进行调整。 拟议中的项目将测试一种针对患者的新型干预措施 和提供者一起做出关于透析治疗的决定。 克服特定的障碍不仅可以改善透析充分性 而且还能提高患者的存活率，降低医疗成本。

DESCRIPTION (adapted from the applicant's abstract): One third of American hemodialysis patients receive inadequate amounts of dialysis. This contributes to dialysis patient mortality rates that are the highest in the industrialized world at 23%/year. Inadequate dialysis probably also contributes to high costs, including an average of two hospitalizations annually per patient and total Medicare expenditures of $10 billion/year. Their prior work identified four factors that are likely to be the most important barriers to adequate dialysis (patient noncompliance, low dialysis prescription, catheter use, and clotting) and documented inadequate patient-provider communication and patient understanding of dialysis adequacy. This proposed community-based randomized controlled trial extends their prior work by targeting these specific barriers to adequate dialysis with a tailored feedback and communication intervention. Thirty dialysis facilities in northeast Ohio will be randomly assigned to intervention and control groups, with 120 patients receiving inadequate dialysis enrolled from 15 intervention and control groups, with 120 patients receiving inadequate dialysis enrolled from 15 intervention facilities and 120 from 15 control facilities. Baseline evaluation will include measures of dialysis delivery, specific barriers, and inpatient expenditures for a six month retrospective interval. Intervention patients and their physicians and nurses will receive tailored feedback on dialysis adequacy and on overcoming patient-specific barriers. They will then meet to formulate a care plan addressing these barriers. Bimonthly progress reports will also be provided to intervention patients and providers over a six month follow-up period. Major analyses will compare changes in dialysis adequacy and hospitalization-related costs in intervention vs. control patients with adjustment for nesting of patients within facilities. The proposed project will test a novel intervention that targets patients and providers as they together make decisions about dialysis treatment. Overcoming specific barriers may lead not only to improved dialysis adequacy but also to better patient survival and decreased health care costs.