Understanding the Initiation of Maintentenance Dialysis among Older Veterans

描述（由申请人提供）： 决定为患有终末期肾病的老年退伍军人启动维持性透析，为提高专科护理价值提供了最大的机会之一。与生命末期进行的其他强化程序类似，老年人中透析的使用存在广泛的区域差异，表明终末期肾病的治疗强度取决于实践方式或医疗资源的供应，而不是受益的可能性。这个项目的目标是确定变异的来源 决定开始透析并确定与接受透析与保守（非透析）治疗相关的特定患者、提供者和机构特征。该项目还将 比较透析与保守护理管理策略的生存和卫生资源利用模式。为了实现这一目标，我们将利用退伍军人事务部的索赔数据、实验室记录和详细的图表审查，组建一个全国性的接近终末期肾病的退伍军人队列。该项目的结果将为干预措施和VA政策的设计提供信息，以促进透析的适当使用。

DESCRIPTION (provided by applicant): The decision to initiate maintenance dialysis for older veterans with end-stage renal disease affords one of the greatest opportunities to improve value in specialty care. Similar to other intensive procedures performed near the end of life, there are wide regional variations in the utilization of dialysis among older adults, suggesting that intensity of treatment for end-stage renal disease is determined by practice style or the supply of medical resources rather than the likelihood of benefit. The goal of this project is to determine the sources of variation underlying the decision to initiate dialysis and to identify specific patient, provider and facility characterstics associated with receipt of dialysis versus conservative (non-dialytic) care. This project will also compare the survival and health resource utilization patterns of dialysis versus conservative care management strategies. To accomplish this goal, we will assemble a national cohort of veterans approaching end-stage renal disease using VA claims data, laboratory records and detailed chart review. The findings from this project will inform the design of interventions and VA policies that promote appropriate use of dialysis.