Rehospitalization after Renal Transplant: Patterns, Predictors, & Implications

描述（由申请人提供）：移植后早期再住院是肾移植受者（KTRs）常见且昂贵的事件。虽然这一结果已被医疗保险和医疗补助服务中心确定为医院的护理质量指标，但尚不清楚肾移植后早期再住院是否代表可预防的事件。一项针对2005年接受了医疗保险的肾移植患者的全国性研究显示，超过一半的患者在移植后的头六个月内再次住院，医疗保险为此花费了3.39亿美元。确定再次住院的危险因素和制定预防再次住院的干预措施一直是许多研究的重点，这些研究的对象包括从充血性心力衰竭到肺炎等各种诊断的患者然而，在ktr中，关于肾移植后早期（定义为<30天）再住院的具体模式和原因的数据很少。该资助的中心前提是考虑到肾移植和肾功能衰竭的基本风险，只有少数肾移植后早期再住院是可以预防的。我们还假设早期再住院可以预测未来的不良后果风险，包括移植物丢失和死亡。我们建议使用单个中心的详细数据对ktr进行回顾性队列研究。该研究设计将使申请人达到以下具体目标：1)通过专家的深入审查，确定肾移植术后早期再住院的原因类别，并根据可预防性对这些原因进行分类；2)确定早期再住院的预测因素；3)确定早期再住院是否是后期不良结局（死亡率、移植物丢失）的独立预测因子。本研究的结果有可能通过确定增加再住院风险的重要的可改变的护理过程因素来改善肾移植后患者的护理。我们将开发一个早期再住院的预测模型，我们将在其他移植中心的ktr队列中进行外部验证。我们还将确定早期再住院是否是日后同种异体移植物丧失的独立预测因素，因为它可能被证明是临床医生易于测量的预后工具。拟议的研究项目将在完成宾夕法尼亚大学临床流行病学硕士学位的背景下进行。学位课程包括流行病学基础和分析方法的强化教学；本课程将加强和指导申请人的研究过程。该资助申请人的长期目标是准备演讲和发表稿件，将结果应用于未来前瞻性研究的设计，并将此研究作为未来k奖申请的基础。

DESCRIPTION (provided by applicant): Early rehospitalization following transplantation is a common and costly event among kidney transplant recipients (KTRs). While this outcome has been identified as a quality of care metric for hospitals by the Centers for Medicare & Medicaid Services, it is not known whether early rehospitalizations after kidney transplant represent preventable events. A national study of Medicare-covered recipients who underwent renal transplant in 2005 revealed that over half were rehospitalized in the first six months, at a cost o 339 million dollars to Medicare.1 Identifying risk factors for rehospitalization and developing interventions to prevent rehospitalization have been a focus of many studies in patients with a variety of diagnoses2 from congestive heart failure3 to pneumonia.4 In KTRs, however, few data exist about the specific patterns and causes of early (defined as <30 days) rehospitalization following kidney transplantation. The central premise of this grant is that give the substantial baseline risks of kidney failure and transplantation, only a minority of early rehospitalizations after kidney transplantation is preventable. We also hypothesize that early rehospitalization predicts future risk of later adverse outcomes including graft loss and death. We propose a retrospective cohort study of KTRs using detailed data from a single center. The study design will enable the applicant to achieve the following Specific Aims: 1) To determine categories of reasons for early rehospitalization after renal transplantation based on expert in-depth review, and to classify these causes according to preventability; 2) To determine predictors of early rehospitalization; and 3) To determine if early rehospitalization is an independent predictor of later adverse outcomes (mortality, graft loss). The results of this study have the potential to improve patient care after kidney transplantation by identifying important modifiable process-of-care factors that increase rehospitalization risk. We will develop a prediction model for early rehospitalization that we will externally validate in a cohort of KTRs a other transplant centers. We will also determine if early rehospitalization is an independent predictor of later allograft loss, as it may prove to be an easily measured prognostic tool for clinicians. The proposed research project will be in the context of completing the Masters of Science in Clinical Epidemiology degree at the University of Pennsylvania. The degree program encompasses intensive instruction on the fundamentals of epidemiology and analytic methods; this coursework will enhance and guide the research process of the applicant. The longer-term objectives of the applicant for this grant are to prepare presentations and manuscripts for publication, apply the results to the design of future prospective studies, and use this study as the foundation of a future K-award application.