Outcomes, Costs and Trends in Dialysis Timing in VA

弗吉尼亚州透析时间的结果、成本和趋势

• 批准号: 8182890
• 负责人: PAUL L. HEBERT
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-10-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8182890
• 关键词: Address; Administrator; Automobile Driving; Benchmarking; Body Weight decreased; Caring; Case Mixes; Chronic; Chronic Kidney Failure; Clinical; Clinical Data; Complex; Consensus; Data; Data Analyses; Data Set; Databases; Decision Making; Dialysis patients; Dialysis procedure; Disease; Doctor of Philosophy; Electrolytes; End stage renal failure; Event; Fatigue; Glomerular Filtration Rate; Goals; Health Benefit; Health system; Healthcare; Healthcare Systems; Heart failure; Incentives; Individual; Information Systems; Investigator-Initiated Research; Kidney; Kidney Failure; Kidney Transplantation; Lead; Link; Logistic Regressions; Measures; Medical; Methodology; Morbidity - disease rate; Nausea; Outcome; Patient Care; Patients; Play; Quality of life; Randomized Controlled Clinical Trials; Registries; Regression Analysis; Renal Replacement Therapy; Renal dialysis; Renal function; Research; Research Priority; Resort; Role; Running; Seminal; Societies; Subgroup; Symptoms; System; Time; United States; Uremia; Variant; Veterans; base; cost; design; early experience; experience; falls; improved; mortality; programs; statistics; trend

Proposal Title: Outcomes, Costs and Trends in Dialysis Timing in VA PI: Paul L. Hebert, PhD PROJECT SUMMARY/ABSTRACT Objectives: Chronic kidney disease (CKD) is a progressively debilitating, highly prevalent, and disproportionately costly disease. Initiation of long-term dialysis has significant financial and quality of life implications for the patient as well as costs to the health care system and society. The decision to dialyze is often based on declining levels of the estimated Glomerular Filtration Rate (eGFR) and patient symptoms of uremia, such as fatigue and weight loss, but optimal timing for dialysis is not well understood. There is little evidence to evaluate the benefits, if any, of referral to dialysis at higher levels of kidney function. The objectives of this study are to address the effects of early versus late dialysis for veterans with chronic kidney disease receiving care at the VA. Specific aims are to 1) determine if trends toward earlier dialysis apparent at the national level are also found within the VA; 2) estimate the health benefits for VA patients of earlier initiation of dialysis compared to later; and 3) estimate the medical cost of earlier initiation of dialysis for VA patients. Research Plan: The proposed study is a retrospective analysis of VA administrative and clinical data, and linked VA-U.S. Renal Data System (USRDS) data. Methodology: For Aim 1, we will identify veterans and non-veterans who initiated dialysis from 1995 to 2007 using the linked VA-USRDS databases. Using descriptive statistics and regression analysis, we will compare trends in early initiation of dialysis (measured by eGFR at dialysis) for VA versus non-VA patients, and explore regional variation in eGFR and variations within and between VA nephrologists. For Aims 2 and 3, we will use a subset of VA patients who initiated dialysis between 2000 and 2006 to estimate the health benefits of early dialysis (eGFR>7) vs. late dialysis. Using a combination of propensity analysis, logistic regression and instrumental variables analysis, we will assess differences in mortality, morbidity and costs for early-dialysis versus late-dialysis patients.

提案标题：弗吉尼亚州透析时机的结果、成本和趋势 PI：Paul L. Hebert 博士 项目概要/摘要 目的：慢性肾脏病（CKD）是一种逐渐使人衰弱、严重的疾病。 流行且代价高昂的疾病。开始长期透析已 对患者的财务和生活质量以及患者的成本产生重大影响 医疗保健系统和社会。透析的决定通常基于肾功能下降 估计肾小球滤过率 (eGFR) 的水平和患者症状 尿毒症，例如疲劳和体重减轻，但透析的最佳时机尚不明确 明白了。几乎没有证据来评估转诊至透析的益处（如果有的话） 肾功能水平较高。本研究的目的是解决影响 患有慢性肾病的退伍军人在医院接受护理的早期与晚期透析的比较 弗吉尼亚州。具体目标是 1) 确定早期透析的趋势是否明显 VA 内还设有国家级； 2) 估计 VA 的健康益处 较早开始透析的患者与较晚开始透析的患者； 3) 估计医疗费用 VA 患者早期开始透析的费用。 研究计划：拟议的研究是对 VA 行政和 临床数据，并链接 VA-U.S.肾脏数据系统（USRDS）数据。 方法：对于目标 1，我们将确定开始透析的退伍军人和非退伍军人 从 1995 年到 2007 年，使用链接的 VA-USRDS 数据库。使用描述性统计 和回归分析，我们将比较早期开始透析的趋势（测量 VA 与非 VA 患者通过透析时的 eGFR 进行比较，并探讨 VA 患者的区域差异 eGFR 以及 VA 肾病专家内部和之间的差异。对于目标 2 和 3，我们将 使用 2000 年至 2006 年间开始透析的 VA 患者子集来估计 早期透析 (eGFR>7) 与晚期透析的健康益处。使用组合 倾向分析、逻辑回归和工具变量分析，我们将 评估早期透析与晚期透析的死亡率、发病率和费用差异 患者。