Veteran Access and Limitations to Organ Recovery (VALOR)

退伍军人器官恢复的机会和限制 (VALOR)

• 批准号: 10365618
• 负责人: Raymond J Lynch
• 金额: $ 58.49万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-10 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10365618
• 关键词: Adherence; Advocacy; Age; American; Area; Authorization documentation; Automated Clinical Decision Support; Awareness; Beds; Caring; Case Study; Cessation of life; Chronic; Clinical; Complex; Consensus; Continuity of Patient Care; Contractor; Data; Elderly; Electronic Health Record; Environment; Evaluation; Failure; Family; Federal Government; Funding; Gifts; Grant; Health; Health system; Healthcare; Hospital Administration; Hospitals; Human Resources; Institution; Intervention; Interview; Kidney; Laboratories; Laws; Life; Liver; Logic; Maps; Measures; Medical; Medical center; Medicine; Minority; Modeling; Monitor; National origin; Operative Surgical Procedures; Organ; Organ Donations; Organ Donor; Organ Procurements; Organ Transplantation; Organ failure; Organization and Administration; Outcome; Patient Care; Patients; Perception; Performance; Physicians; Physiological; Population; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Process; Provider; Quality of Care; Race; Recovery; Research; Risk Factors; Role; Rural; Sampling; Savings; Source; Standardization; Structure; Support System; Surveys; System; Transplantation; Underserved Population; United States; United States Department of Veterans Affairs; Veterans; Vulnerable Populations; Waiting Lists; authority; base; biomedical referral center; body system; care coordination; care outcomes; clinical decision support; cost; critical care nursing; disability; disadvantaged population; ethnic minority; experience; follow-up; health practice; improved; interest; marginalized population; meetings; military veteran; minority patient; older patient; organ procurement transplantation network; patient advocacy group; patient oriented; patient population; programs; prospective; racial minority; radiological imaging; response; rural area; screening; sociodemographics; support tools; symposium; virtual; Adherence; Advocacy; Age; American; Area; Authorization documentation; Automated Clinical Decision Support; Awareness; Beds; Caring; Case Study; Cessation of life; Chronic; Clinical; Complex; Consensus; Continuity of Patient Care; Contractor; Data; Elderly; Electronic Health Record; Environment; Evaluation; Failure; Family; Federal Government; Funding; Gifts; Grant; Health; Health system; Healthcare; Hospital Administration; Hospitals; Human Resources; Institution; Intervention; Interview; Kidney; Laboratories; Laws; Life; Liver; Logic; Maps; Measures; Medical; Medical center; Medicine; Minority; Modeling; Monitor; National origin; Operative Surgical Procedures; Organ; Organ Donations; Organ Donor; Organ Procurements; Organ Transplantation; Organ failure; Organization and Administration; Outcome; Patient Care; Patients; Perception; Performance; Physicians; Physiological; Population; Positioning Attribute; Practical Robust Implementation and Sustainability Model; Process; Provider; Quality of Care; Race; Recovery; Research; Risk Factors; Role; Rural; Sampling; Savings; Source; Standardization; Structure; Support System; Surveys; System; Transplantation; Underserved Population; United States; United States Department of Veterans Affairs; Veterans; Vulnerable Populations; Waiting Lists; authority; base; biomedical referral center; body system; care coordination; care outcomes; clinical decision support; cost; critical care nursing; disability; disadvantaged population; ethnic minority; experience; follow-up; health practice; improved; interest; marginalized population; meetings; military veteran; minority patient; older patient; organ procurement transplantation network; patient advocacy group; patient oriented; patient population; programs; prospective; racial minority; radiological imaging; response; rural area; screening; sociodemographics; support tools; symposium; virtual

Abstract: Deceased donors provide lifesaving gifts to patients with chronic organ failure. Organ donation occupies a unique position in American healthcare, as donation care is provided without cost to the patient or their family and is mandated to be provided without bias to age, disability, race, or national origin by federal contractors known as organ procurement organizations (OPOs). Previous regulatory measures of OPO performance did not allow adequate objectivity, reliability, and transparency into procurement practice and have been replaced by a new metric introduced by this study's authors. Analyses using this metric reveal that older persons, minorities, and those living in poor, rural, and remote areas receive lesser access to organ donation. Veterans Administration Medical Centers (VAMCs) represent the largest single hospital system in the United States, and serve a population recognized to be underserved in many aspects of health and medicine. We have developed preliminary data showing that VAMCs recover deceased donor organs at a rate of 4% that of non-VA hospitals. The basis for this disparity is unclear, but given the high concentration of vulnerable and underserved groups at VAMCs, there is a strong imperative to improve donation access for these patients. In this proposal, we will leverage VAMCs' unparalleled electronic health records (EHRs), which offer detailed information on longitudinal patient care and outcomes, to enumerate the potential supply of organ donors nationwide over a 10-year historical period. We will use physiologic, laboratory, and radiographic data to define potential donor quality and estimate transplant yields at varying levels of donation performance relative to non-VA hospitals. We will also interview patients, critical care nurses and physicians at VAMCs, and OPO personnel to gather their experiences and perceptions regarding barriers to more effective donor recovery from these institutions. We will use findings from these qualitative and VA EHR studies to inform a consensus conference on best practices for improved organ donation care at VAMCs in year 2 of our project. Based on the findings of the first two aims in this study, we will create a model for improved VAMC donation care using a large, nationally-representative sample of VAMCs and their attendant OPOs. We will introduce a clinical decision support tool into VA EHR to maximize referral of potential donors. Study staff will integrate with OPOs in responding to VAMC referrals, utilizing VA EHR sources to assist in evaluating patients for donation. Study coordinators will facilitate workflow between VAMC and OPO staff, supporting and monitoring adherence to best practices defined in the consensus conference. We will conduct a follow-up stakeholder meeting to assess perceptions of the pilot program's efficacy among VAMC providers, OPO staff, and veteran and patient advocacy groups from within the study area. Together, this study's findings will not only help to ameliorate disparities in veterans' access to donation care, but will inform efforts to standardize and improve donation care among other underserved populations.

摘要：已故捐助者为患有慢性器官衰竭的患者提供救生礼物。器官捐赠 在美国医疗保健中占有独特的立场，因为提供捐赠护理而无需为患者或 他们的家人并被授权在没有偏见的情况下对年龄，残疾，种族或国籍由联邦 承包商称为器官采购组织（OPO）。以前的OPO监管措施 绩效不允许对采购实践的充分客观性，可靠性和透明度和 已被本研究作者引入的新指标所取代。使用此指标的分析表明 老年人，少数族裔以及生活在贫困，农村和偏远地区的人获得器官的访问量较低 捐款。退伍军人管理医疗中心（VAMC）代表了最大的单一医院系统 美国，为公认在健康和医学的许多方面服务不足的人群服务。 我们已经开发了初步数据，表明VAMC以4％的速度恢复已故的捐赠者器官 非VA医院。这种差异的基础尚不清楚，但是鉴于易受伤害和 在VAMCS的服务组不足，必须有很强的需要改善这些患者的捐赠机会。 在此提案中，我们将利用VAMCS的无与伦比的电子健康记录（EHR） 有关纵向患者护理和结果的详细信息，以列举器官的潜在供应 全国捐助者在十年的历史时期。我们将使用生理，实验室和放射线数据 定义潜在的供体质量并在不同水平的捐赠绩效水平下估算移植产量 相对于非VA医院。我们还将采访VAMCS的患者，重症监护护士和医生，以及 OPO人员收集他们关于更有效捐助者障碍的经验和看法 从这些机构中恢复。我们将使用这些定性和VA EHR研究中的发现来告知 在我们项目的第二年，在VAMCS改善器官捐赠护理的最佳实践会议上共识会议。 根据本研究的前两个目标的发现，我们将创建一个改进VAMC的模型 使用大型的，全国代表性的VAMC及其服务员OPO的捐赠护理。我们将 将临床决策支持工具引入VA EHR，以最大程度地推荐潜在的捐助者。学习人员会 与OPO响应VAMC推荐，利用VA EHR来源协助评估患者 捐赠。研究协调员将促进VAMC与OPO员工之间的工作流程，支持和 监视共识会议中定义的最佳实践的依从性。我们将进行后续 利益相关者会议，以评估VAMC提供商，OPO员工，OPO员工的效力的看法， 研究区域内的退伍军人和患者倡导群体。 这项研究的发现不仅将有助于改善退伍军人获得捐款的差异 护理，但会为标准化和改善其他服务不足的人群提供标准化和改善捐赠护理的努力。