Case-Mix and its Effects on Quality Indicators in ESRD

ESRD 病例组合及其对质量指标的影响

• 批准号: 6825510
• 负责人: DANA C MISKULIN
• 金额: $ 12.58万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-15 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6825510
• 关键词: behavioral /social science research tag; chronic renal failure; clinical research; comorbidity; health care professional practice; health care quality; health care service evaluation; health services research tag; hemodialysis; hospital utilization; human data; human mortality; human subject; longitudinal human study; outcomes research; patient oriented research; quality of life; satisfaction

DESCRIPTION (provided by applicant): Quality monitoring (QM) programs have been established to ensure that acceptable standards of care are delivered at US dialysis facilities. Global improvements have been made, but novel approaches are needed. The current QM reports do not account for differences in case-mix severity among dialysis facilities. Units caring for sicker patients are unfairly scrutinized while those with substandard care pass unnoticed. The assurances and objectives of a QM program are undermined if reporting methods are biased. The growing disparity between health care costs and resources threatens the quality of care delivered. As dialysis facilities are pressured to achieve results but struggle to balance budgets, facilities may select against high-risk patients. There is a great need to identify unbiased quality measures that promise improved outcomes. A unique strength of this proposal is the wealth of comorbidity and case-mix data collected in three contemporary and recent dialysis populations (n=5490). The three populations will be pooled. Case-mix severity scores for mortality and hospitalization use will be developed through multivariable regression modeling. Hierarchical models will be constructed to assess relationships of patient-specific and facility-specific factors with a number of process and outcome quality indicators, accounting for the clustering of patients within facilities. Also, through more complete accounting for of case-mix differences, relationships of facility-specific practices that are hypothesized to impact on process and outcomes, will be identified. A prospective study to test the feasibility of collecting comorbidity in routine practice and the validity of the predictive instruments will be initiated. The principal investigator holds a Master's degree in Epidemiology and the career development program will build on the candidate's skills and experience to enable her to lead future studies to improve outcomes patients with chronic kidney disease

描述（由申请人提供）： 已经建立了质量监测（QM）计划，以确保在美国透析设施提供可接受的护理标准。已经进行了全球改进，但是需要新颖的方法。当前的QM报告没有说明透析设施中病例混合严重程度的差异。照顾病患者的单位受到不公平的审查，而那些不合格的护理通行证没有注意到。如果报告方法有偏见，QM计划的保证和目标将受到破坏。医疗保健成本和资源之间的差异日益差异威胁到提供的护理质量。由于透析设施被迫取得成果，但要平衡预算，因此设施可能会针对高风险患者选择。非常需要确定有望改善结果的公正质量措施。 该提议的一个独特优势是合并症的丰富和案例混合数据，这些数据收集了三个当代和最近的透析人群（n = 5490）。这三个人群将被合并。死亡率和住院使用情况的病例混合严重程度得分将通过多变量回归建模开发。将构建分层模型，以评估患者特异性和设施特异性因素与许多过程和结果质量指标的关系，这考虑了设施中患者的聚类。同样，通过对案例混合差异的更完整的核算，将确定被认为会影响过程和结果的设施特定实践的关系。将启动一项前瞻性研究，以测试在常规实践中收集合并症和预测工具的有效性的可行性。 首席研究人员拥有流行病学硕士学位，职业发展计划将基于候选人的技能和经验，使她能够领导未来的研究，以改善患有慢性肾脏病的患者