Chronic Kidney Disease in Disadvantaged Populations

弱势群体的慢性肾脏病

• 批准号: 8076339
• 负责人: Yoshio N. Hall
• 金额: $ 17.28万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8076339
• 关键词: Accident and Emergency department; Acute; Acute Renal Failure with Renal Papillary Necrosis; Adherence; Affect; Age; American; Anemia; Angiotensins; Applications Grants; Appointment; Area; Asians; California; Caring; Cessation of life; Chronic Kidney Failure; Clinical Research; Community Health Networks; Country; Data; Data Sources; Detection; Development; Diabetes Mellitus; Diagnostic tests; Dialysis procedure; Disadvantaged; Disease Progression; Early identification; Educational Intervention; Effectiveness; End stage renal failure; Enrollment; Epidemiologic Methods; Epidemiologic Studies; Epidemiology; Ethnic Origin; Evaluation; Funding; Goals; Grant; Head; Health Insurance; Health Status; Health system; Healthcare; High Prevalence; Hispanics; Hospitalization; Immunization; Individual; Information Centers; Information Systems; Internal Medicine; Intervention; Intervention Studies; K-Series Research Career Programs; Kidney; Lipids; Low Income Population; Low income; Measures; Medicaid; Medical center; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Minority Groups; Morbidity - disease rate; Nephrology; Northwestern United States; Not Hispanic or Latino; Obesity; Outcome; Outcomes Research; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Population Heterogeneity; Progressive Disease; Provider; Public Health; Public Hospitals; Race; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Renal function; Research; Research Institute; Research Personnel; Risk; Risk Factors; Self Care; Series; Societies; Staging; Statistical Methods; System; Testing; Training; Underserved Population; United States; United States National Institutes of Health; Universities; Ursidae Family; Visit; Washington; base; care delivery; cohort; cost; cost effectiveness; data registry; design; disability; disease registry; electronic data; experience; health care service utilization; health information technology; health literacy; high risk; improved; inhibitor/antagonist; literacy; medically underserved population; member; mortality; patient oriented; professor; programs; public health relevance; racial and ethnic; safety net; sex; socioeconomics; tool

DESCRIPTION (provided by applicant): This is an application for a K23 award for Dr. Yoshio Hall, an Assistant Professor in nephrology at the University of Washington. Dr. Hall is establishing himself as a young investigator in patient-oriented clinical research of chronic kidney disease (CKD) in medically underserved populations. This K23 award will provide Dr. Hall with training and mentored research experience in the following areas: (1) recruiting and maintaining a patient cohort; (2) performing and validating diagnostic tests; (3) developing and maintaining a CKD registry from multiple data sources; (4) training in health information technology, (5) training in advanced statistical and epidemiologic methods; and (6) designing pilot intervention studies. To achieve these goals, Dr. Hall has assembled a mentoring team comprised of a primary mentor, Dr. Jonathan Himmelfarb, Director of the Kidney Research Institute and Professor of Medicine, who is recognized internationally as a leader in translational and outcomes research in persons with end-stage renal disease (ESRD) and acute kidney injury, and two co-mentors: Dr. Edward Boyko, Acting Head of the Division of General Internal Medicine at the University of Washington and former Director of the VA-funded Epidemiologic Research and Information Center, who is an internationally known investigator in the epidemiology of diabetes and obesity with extensive experience in disease registry development and management; and Dr. Glenn Chertow, Chief of Nephrology and Professor of Medicine at Stanford University, who is internationally recognized as a leader in improving care for persons with acute and chronic kidney disease . Chronic kidney disease (CKD) is an important public health problem which affects more than 26 million Americans. In the US, members of racial-ethnic minority groups and low-income populations bear a disproportionate burden of CKD, particularly ESRD. We hypothesize that the disparate rates of ESRD among these at-risk groups reflect a pattern of underutilization of care. We further hypothesize that public health systems which disproportionately care for diverse populations do not consistently identify or provide recommended care to persons with CKD who are at highest risk for progressive disease. We will test these hypotheses using a series of analyses that leverage data from (1) Harborview Medical Center, the largest public hospital system in the northwestern United States; and (2) The Community Health Network, a large safety net health system in northern California. This research will form the basis for patient-centered interventions to improve the delivery of care to diverse populations. Public health relevance: Improved understanding of local- and system-level barriers to care delivery in historically disadvantaged populations may reduce pervasive racial-ethnic and socioeconomic disparities in care and decrease the growing burden of CKD and ESRD to society. PUBLIC HEALTH RELEVANCE: Chronic kidney disease is defined as the presence of persistent kidney damage and/or loss of kidney function. In the United States, chronic kidney disease affects an estimated 27 million Americans and is associated with substantial morbidity, mortality and cost. In this country, racial-ethnic minority groups and low-income populations bear a disproportionate burden of chronic kidney disease, particularly end-stage renal disease. The central hypotheses of this proposal are that modifiable local- and system-level factors can be identified which influence the delivery of care and impact long-term risk for development and progression of chronic kidney disease to ESRD among disadvantaged populations.

描述（由申请人提供）：这是华盛顿大学肾病学助理教授 Yoshio Hall 博士的 K23 奖项申请。 Hall 博士正在将自己定位为一名年轻的研究者，致力于以患者为导向的医疗服务不足人群中的慢性肾病 (CKD) 临床研究。该 K23 奖项将为 Hall 博士提供以下领域的培训和指导研究经验：（1）招募和维持患者队列； (2) 执行并验证诊断测试； (3) 开发和维护来自多个数据源的 CKD 注册表； (4) 卫生信息技术培训， (5) 高级统计和流行病学方法培训； (6) 设计试点干预研究。为了实现这些目标，Hall 博士组建了一个指导团队，由主要导师、肾脏研究所所长兼医学教授 Jonathan Himmelfarb 博士组成，他是国际公认的糖尿病患者转化和结果研究领域的领导者。终末期肾病 (ESRD) 和急性肾损伤，以及两位共同导师：Edward Boyko 博士，华盛顿大学普通内科代理主任，VA 资助的流行病学研究和信息部前主任Center，是国际知名的糖尿病和肥胖流行病学研究者，在疾病登记开发和管理方面拥有丰富的经验；斯坦福大学肾病科主任兼医学教授 Glenn Chertow 博士是国际公认的改善急慢性肾病患者护理的领导者。慢性肾病 (CKD) 是一个重要的公共卫生问题，影响着超过 2600 万美国人。在美国，少数族裔群体和低收入人群承受着不成比例的 CKD 负担，尤其是 ESRD。我们假设这些高危人群的 ESRD 发生率不同反映了护理利用不足的模式。我们进一步假设，不成比例地照顾不同人群的公共卫生系统不能始终如一地识别或向进展性疾病风险最高的 CKD 患者提供推荐的护理。我们将使用一系列分析来检验这些假设，这些分析利用来自 (1) 美国西北部最大的公立医院系统港景医疗中心 (Harborview Medical Center) 的数据； (2) 社区健康网络，这是北加州的一个大型安全网络卫生系统。这项研究将为以患者为中心的干预措施奠定基础，以改善对不同人群的护理服务。公共卫生相关性：提高对历史上弱势群体提供护理服务的地方和系统层面障碍的了解，可能会减少护理方面普遍存在的种族、民族和社会经济差异，并减轻 CKD 和 ESRD 给社会带来的日益沉重的负担。 公众健康相关性：慢性肾病的定义是存在持续性肾损伤和/或肾功能丧失。在美国，慢性肾病影响了大约 2700 万美国人，并且与大量的发病率、死亡率和费用相关。在这个国家，少数族裔群体和低收入人群承受着不成比例的慢性肾病负担，特别是终末期肾病。该提案的中心假设是，可以确定可修改的局部和系统层面的因素，这些因素会影响护理的提供，并影响弱势群体中慢性肾病发展和进展为 ESRD 的长期风险。