Impact of the ESRD Treatment Choices Model on Home Dialysis Uptake and Disparities

项目总结/摘要 Sri Lekha Tummalapalli博士是一名肾病学家和卫生服务研究人员，其长期目标是 成为研究医疗保健政策和交付系统干预的领先国家专家，以优化 肾病患者护理的质量和公平性。如果获奖，这K 08指导的职业生涯 发展奖将为Tummalapalli博士提供必要的保护时间和培训，以发展 变成了独立的医生调查员Tummalapalli博士将主要由Lawrence博士指导 卡萨利诺，人口健康科学的利文斯顿法兰德教授和替代支付专家 模型和医疗保健提供系统的组织。在多学科的指导下， 导师团队，Tummalapalli博士将参与严格的培训和职业发展计划， 以下3个领域：（1）评估医疗保健提供系统的定性研究（Lawrence卡萨利诺博士）， (2)准实验研究设计（包玉华博士）和先进的流行病学方法（米歇尔博士 Estrella），以及（3）使用大型索赔数据库来检查护理的质量和公平性（Sumit Mohan博士， 博士易卜拉欣说）。Tummalapalli博士将在环境优美的 威尔康奈尔大学医学部人口健康科学，周围是国际公认的 卫生服务研究、卫生经济学、流行病学和生物统计学专家。 需要透析的终末期肾病（ESRD）造成巨大的临床和经济负担， 影响超过55万美国人，每年花费约490亿美元。家庭透析是首选的治疗方法， ESRD，提供比中心血液透析更好的生活质量，成本更低。然而，家庭透析的使用率 低，在接受方面存在明显的种族/族裔和社会经济差异。对以下方面的了解有限： 组织结构和流程可提高家庭透析使用率并减少差异。这 该提案采用严格的卫生服务研究技术来检查ESRD治疗选择（ETC） 模型，一种激励家庭透析使用的随机替代支付模型。利用定性 访谈和国家大型索赔数据库，这项研究的目的是（1）确定结构的变化， （2）确定设施和实践结构和过程， 与家庭透析摄取相关的护理;以及（3）评估ETC模型对社会经济和 家庭透析使用的种族/民族差异。在这个项目中获得的知识很有可能 通过揭示有效的肾脏疾病治疗， 护理结构、护理过程和政策杠杆，增加家庭透析使用率， 差距。这项工作将为Tummalapalli博士提供技能和研究经验，使其成为 研究肾脏病支付和交付系统改革的独立医生调查者很少。

PROJECT SUMMARY/ABSTRACT Dr. Sri Lekha Tummalapalli is a nephrologist and health services researcher whose long-term goal is to become a leading national expert studying healthcare policies and delivery system interventions to optimize the quality and equity of care for patients with kidney disease. If awarded, this K08 mentored career development award will provide Dr. Tummalapalli with the necessary protected time and training to develop into an independent physician-investigator. Dr. Tummalapalli will be mentored primarily by Dr. Lawrence Casalino, the Livingston Farrand Professor of Population Health Sciences and an expert in alternative payment models and the organization of the healthcare delivery system. Under the guidance of a multidisciplinary mentorship team, Dr. Tummalapalli will engage in a rigorous training and career development plan in the following 3 areas: (1) qualitative research for evaluating healthcare delivery systems (Dr. Lawrence Casalino), (2) quasi-experimental research designs (Dr. Yuhua Bao) and advanced epidemiologic methods (Dr. Michelle Estrella), and (3) the use of large claims databases to examine quality and equity of care (Dr. Sumit Mohan, Dr. Said Ibrahim). Dr. Tummalapalli will conduct her research and training in the outstanding environment of Weill Cornell Medicine’s Department of Population Health Sciences, surrounded by internationally recognized experts in health services research, health economics, epidemiology, and biostatistics. End-stage renal disease (ESRD) requiring dialysis causes an enormous clinical and economic burden, affecting over 550,000 Americans and costing ~$49 billion annually. Home dialysis is a preferred treatment for ESRD, offering better quality of life than in-center hemodialysis at reduced cost. Yet, uptake of home dialysis is low and there are stark racial/ethnic and socioeconomic disparities in uptake. There is limited understanding of organizational structures and processes that lead to higher home dialysis uptake and reduced disparities. This proposal applies rigorous health services research techniques to examine the ESRD Treatment Choices (ETC) Model, a randomized alternative payment model that incentivizes home dialysis uptake. Leveraging qualitative interviews and national large claims databases, this research aims to (1) Identify changes in structures and processes of care in response to the ETC Model; (2) Identify facility and practice structures and processes of care associated with home dialysis uptake; and (3) Assess the impact of the ETC Model on socioeconomic and racial/ethnic disparities in home dialysis uptake. The knowledge gained in this project is highly likely to influence healthcare policy and the delivery of kidney disease care on the national scale by revealing effective structures of care, processes of care, and policy levers that increase home dialysis uptake and reduce disparities. This work will equip Dr. Tummalapalli with the skills and research experience to become one of the few independent physician-investigators studying nephrology payment and delivery system reform.