Patient Safety and Acute Kidney Injury

简介(由申请人提供)：布朗博士在保罗·巴特登博士(硕士)和杰拉尔德·T·奥康纳博士(博士学位)的指导下，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。他目前是达特茅斯卫生政策和临床实践研究所的一名成功的讲师，致力于晋升为达特茅斯大学的终身教职助理教授，致力于心血管干预中的患者安全问题。导师：Gerald T.O‘Connor博士，博士，SCD，是心血管疾病和患者安全领域的著名流行病学家和卫生服务研究员，在AHRQ K-08、AHRQ K-02和NCI K-05支持下成功指导职业发展奖获得者的长期记录。Mark J.Sarnak博士，医学博士，医学硕士，是慢性肾脏疾病和老龄化方面的专家和研究员，有NIH资助和指导的历史。O‘Connor博士和Sarnak博士将与担任布朗博士顾问委员会的一批领先研究人员一起，确保布朗博士的研究培训、项目和整体职业发展取得成功。研究：经皮冠状动脉介入治疗(PCI)的患者安全是一个问题，每年在美国有超过120万患者受到影响。造影剂诱导的急性肾损伤(CI-AKI)被认为是国家质量论坛的一个重要的患者安全目标。CI-AKI是导致慢性肾脏疾病(CKD)、终末期肾脏疾病(ESRD)和经皮冠状动脉介入治疗(PCI)后死亡的并发症。一个主要问题是缺乏预防策略，缺乏对CI-AKI风险患者安全的对比剂剂量，以及心脏病和肾脏病之间的过渡护理。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；以及2)评估CI-AKI是否与CKD的发展、CKD的进展、ESRD的发展、重复血管重建和长期死亡率有关。对于特定的目标1和2，我们将前瞻性地在新英格兰北部心血管疾病研究组(N=32,000)的8个中心实施高强度质量改进，收集每个中心团队的住院结果、长期死亡率、ESRD、重复血管重建以及关于成功和改进障碍的定性数据。对于目标2，我们还将使用退伍军人健康管理局的管理数据来调查CI-AKI的问题，方法是利用2003-2007年的患者治疗文件和实验室文件来确定冠状动脉介入治疗队列(N=30,000)以及随后的肾脏并发症和死亡。这两个目标都专注于提供高质量的、以患者为中心的护理。在完成这一职业发展奖后，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调查员。 公共卫生相关性：在美国，每年有200多万例心脏手术；这些手术使用造影剂进行成像，直接伤害或严重损害患者的肾脏。因此，每年有超过20万名患者因造影剂造成肾脏损伤，导致透析和死亡。我们将与不同学科的临床医生合作，提高患者的安全性，防止肾脏损伤，并确定可以修改的早期风险因素，以降低器官损伤的风险。

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.