Home-based conservative care model for advanced kidney disease

晚期肾病的家庭保守治疗模式

• 批准号: 10535360
• 负责人: Susan Pamela Wong
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10535360
• 关键词: Accident and Emergency department; Address; Admission activity; Advance Care Planning; Age; Caregiver Burden; Caregivers; Caring; Cessation of life; Chronic Disease; Chronic Kidney Failure; Collaborations; Complex; Computer software; Data; Data Analyses; Developed Countries; Dialysis procedure; Disease; Disease Progression; Dose; Elements; Enrollment; Ethnography; Family; Geriatrics; Goals; Health; Health Care Costs; Health Personnel; Healthcare; Healthcare Systems; Home; Hospitalization; Improve Access; Infrastructure; Inpatients; Investigation; Kidney; Kidney Diseases; Life; Life Style; Link; Long-Term Care; Maintenance; Measures; Medical Records; Medicare; Methodology; Minority; Modeling; Natural Language Processing; Nursing Homes; Observational Study; Outcome; Outpatients; Palliative Care; Patient Care; Patients; Pattern; Persons; Physical Function; Pilot Projects; Policy Maker; Primary Care; Publications; Quality of life; Randomized; Readiness; Renal function; Research Methodology; Retrospective cohort; Surveys; Symptoms; Therapeutic; Veterans; Veterans Hospitals; acceptability and feasibility; aged; career networking; cognitive function; comorbidity; comparative effectiveness trial; cost; end of life; evidence base; health care availability; health care service utilization; hospice environment; human old age (65+); improved; innovation; interdisciplinary approach; member; multidisciplinary; multiple chronic conditions; novel; older patient; patient oriented; pilot test; pilot trial; preference; programs; satisfaction; sound; symposium; symptom management; treatment as usual

PROJECT SUMMARY/ABSTRACT Background: Conservative care (CC) is an important therapeutic option for Veterans who do not wish to pursue maintenance dialysis for their advanced chronic kidney disease (CKD) and offers a whole-person, multidisciplinary approach to care that is focused on slowing disease progression, active symptom management, advance care planning, and provision of appropriate palliative care. Recent evidence from observational studies of CC programs in other developed countries indicate that for older patients (aged ≥75 years) with significant comorbidity and functional limitation, dialysis may not meaningfully lengthen survival or improve quality of life beyond what can be achieved with CC. Although 1 in 7 Veterans with advanced CKD do not pursue dialysis, there are no formal CC programs within the VA and few, if any, concerted efforts to establish these programs in non-VA settings. While CC programs do not currently exist in the VA, many of the elements of CC programs found in other developed countries and that are desirable to Veterans, families, and healthcare providers can be found in the VA’s Home-Based Primary Care (HBPC) program. HBPC provides home-based multidisciplinary primary care to Veterans with multimorbidity and functional limitation with the goal of supporting Veterans’ quality of life and mitigating the complications of illness through to the end of life. We hypothesize that the multidisciplinary care (MDC) framework of HBPC serves as the ideal starting ground to build the VA’s first CC program for Veterans with advanced CKD. Significance: The current proposal is a collaboration with operational partners in HBPC, VA Geriatrics and Extended Care Data Analysis Center, and the VA National Kidney Program. It addresses HSRD priorities of improving access to care, healthcare values, management of complex chronic illness, and long-term care by increasing the evidence base for HBPC and filling outstanding care gaps for Veterans with advanced CKD. Innovation and Impact: The proposal will lead to: 1) the first comprehensive investigation of CKD-relevant outcomes associated with receipt of HBPC; and 2) the creation of the first evidence-based CC program for Veterans with advanced CKD in the VA, if not the nation. Specific Aims: Aim 1: To evaluate the impact of the HBPC MDC model on CKD-specific outcomes; and Aim 2: To assess the feasibility and acceptability of a novel CC Program delivered through the MDC infrastructure of HBPC among Veterans with advanced CKD, their caregivers and clinicians and explore preliminary outcomes of this Program. Methodology: Aim 1 is an emulated hypothetical comparative effectiveness “trial” using observational data for a national retrospective cohort of Veterans with advanced CKD. We will use linked VA and Medicare data and augmented VA medical record review using novel natural language processing software to determine the impact of different patterns of MDC provided by HBPC on downstream treatment practices for advanced CKD. Aim 2 is a randomized pilot trial of 30 Veterans with advanced CKD, their caregivers and clinicians using ethnographic research methods to assess the feasibility and acceptability of a novel CC Program for advanced CKD delivered through the existing MDC infrastructure of the HBPC program at VA Puget Sound Health Care System. We will also use medical record review and serial surveys to collect information on CKD progression, quality of life, goal concordant care, caregiver burden, clinician effort, and healthcare utilization and costs. Next Steps: Our proposal is a foundational and necessary step in our efforts to expand treatment options for advanced CKD and to create a scalable, sustainable, and effective model of CC for Veterans with advanced CKD. The findings will be widely disseminated through publications, presentations at national conferences and professional networks of the study team members who are highly connected with policy makers at national VA agencies.

项目概要/摘要 背景：对于不想接受治疗的退伍军人来说，保守治疗（CC）是一种重要的治疗选择。 为晚期慢性肾病 (CKD) 进行维持性透析，并提供全人、 多学科护理方法，重点是减缓疾病进展、活动症状 管理、预先护理计划以及提供适当的姑息治疗的最新证据。 其他发达国家 CC 项目的观察性研究表明，对于老年患者（年龄≥75 岁） 年）具有显着的合并症和功能限制，透析可能不会有意义地延长生存期或 尽管七分之一患有晚期 CKD 的退伍军人确实可以改善生活质量，但 CC 无法达到这一效果。 不进行透析，VA 内没有正式的 CC 计划，并且很少（如果有的话）共同努力 在非 VA 环境中建立这些计划虽然 VA 中目前不存在 CC 计划，但其中许多计划。 其他发达国家的 CC 计划的要素对退伍军人、家庭和人员来说是理想的 可以在 VA 的家庭初级保健 (HBPC) 计划中找到医疗保健提供者。 为患有多种疾病和功能受限的退伍军人提供以家庭为基础的多学科初级保健 支持退伍军人的生活质量并减轻疾病并发症直至生命终结的目标。 我们致力于将 HBPC 的多学科护理 (MDC) 框架作为理想的起点 为具有高级 CKD 的退伍军人建立 VA 的第一个 CC 项目 意义：当前的提案是一个。 与 HBPC、VA 老年病学和延伸护理数据分析中心的运营合作伙伴合作，以及 VA 国家肾脏计划解决了 HSRD 的优先事项，即改善获得护理的机会、医疗保健价值观、 通过增加 HBPC 的证据基础来管理复杂的慢性病和长期护理 通过先进的 CKD 创新和影响来填补退伍军人的突出护理空白：该提案将引领。 1) 首次全面调查与接受 HBPC 相关的 CKD 相关结果；以及 2) 为 VA 中患有晚期 CKD 的退伍军人创建第一个基于证据的 CC 计划 具体目标：目标 1：评估 HBPC MDC 模型对 CKD 特定结果的影响； 目标 2：评估通过 MDC 交付的新型 CC 计划的可行性和可接受性 HBPC 基础设施在患有高级 CKD 的退伍军人、他们的护理人员和顾客中的应用，并探索 该计划的初步成果：目标 1 是模拟的假设比较。 使用全国晚期退伍军人回顾性队列的观察数据进行有效性“试验” 我们将使用关联的 VA 和医疗保险数据，并使用新型天然药物增强 VA 医疗记录审查。 语言处理软件，用于确定 HBPC 提供的不同 MDC 模式对 晚期 CKD 的下游治疗实践目标 2 是一项对 30 名患有慢性肾病的退伍军人进行的随机试点试验。 先进的 CKD、他们的护理人员和战士使用人种学研究方法来评估可行性 通过现有 MDC 基础设施交付的用于高级 CKD 的新型 CC 计划的可接受性 我们还将使用医疗记录审查和 VA Puget Sound 医疗保健系统的 HBPC 计划。 系列调查收集有关 CKD 进展、生活质量、目标一致护理、护理人员的信息 负担、临床医生的努力以及医疗保健利用和成本：我们的建议是基础性的和成本的。 我们努力扩大晚期 CKD 的治疗选择并创建可扩展的、 针对患有晚期 CKD 的退伍军人的可持续且有效的 CC 模型研究结果将得到广泛应用。 通过出版物、在国家会议和专业网络上的演讲进行传播 研究小组成员与国家退伍军人事务部机构的政策制定者关系密切。