Does geographic access to care impact pediatric ESRD outcomes?

地理上获得护理的机会是否会影响儿科终末期肾病 (ESRD) 的结局？

• 批准号: 8772467
• 负责人: Sandra Amaral
• 金额: $ 9.23万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8772467
• 关键词: Accounting; Address; Adherence; Adult; Affect; Age; Area; Automobile Driving; Child; Childhood; Code; Communities; Community Health; Complex; Data; Disease Outcome; End stage renal failure; Environment; Environmental Policy; Environmental Risk Factor; Evaluation; Family; Future; Geographic Information Systems; Geography; Goals; Health; Health Services Accessibility; Health Status; Health behavior; Healthcare; Healthy People 2020; Housing; Human; Individual; Institution; Intervention; Kidney; Kidney Transplantation; Life; Living Donors; Measures; Metric; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Neighborhoods; Operative Surgical Procedures; Organ; Outcome; Patients; Persons; Plant Roots; Poverty; Probability; Process; Research Personnel; Resources; Risk; Role; Science; Services; Social Environment; Statistical Models; Techniques; Testing; Time; Transplantation; Travel; United States Dept. of Health and Human Services; United States National Institutes of Health; Waiting Lists; base; care seeking; design; effective intervention; experience; geographic difference; health disparity; high risk; improved; innovation; insight; novel; organ allocation; public health relevance; research study; residence; social; social health determinants

DESCRIPTION (provided by applicant): The Department of Health and Human Services Final Rule states that organ allocation "shall not be based on the candidate's place of residence or place of listing", yet depending on where a child lives, his median waiting time for a deceased donor kidney transplant varies from 14-1313 days. Beyond individual factors, we do not understand why such wide geographic variation in pediatric kidney transplant access exists. The broad, long- term objective of this proposal is to move science forward by informing targeted interventions to reduce disparities in transplant access for children with end-stage renal disease (ESRD). This study will use novel geospatial analytical approaches to characterize the attributes of where children with ESRD live and where they seek transplantation, and we will gain insight into how these attributes interact to influence access to pediatric wait listing and transplant. Using an innovative ecological model which incorporates individual, community-level and institutional-level factors, we will disentangle the multiple factors which contribute to differental access to kidney transplant for children. For Aim 1, we will use robust national data to empirically derive a community-level health risk score for each patient's residential neighborhood and evaluate whether community-level health risk impacts transplant access. We hypothesize that children living in communities with less favorable social determinants of health will experience longer time from incident ESRD to wait listing and lower probability of transplant. For Aim 2, we will examine how community-level health risks interact with geospatial access to transplant for children with incident ESRD. We hypothesize that children living in "lower-risk" communities will have shorter time from incident ESRD to wait listing and increased probability of transplant, regardless of geospatial access to transplant centers; whereas for children living in "higher-risk" communities, less geospatial access to transplant will pose a significant barrier to wait listing and transplant. We will measure "geospatial access" using multiple metrics of the proximity of a patient's residence ZIP code to surrounding transplant centers, including travel distance and time. By examining the dynamic interplay of geography, community-level health and pediatric kidney transplant access, we will be able to identify how and where interventions should be implemented to reduce disparities. These results will inform the national discourse on how to improve quality, equity and access to care for all children. The NIH and NIDDK have emphasized the need for more rigorous research studies to 1) increase understanding of community influences on health behaviors and 2) to develop and test more effective interventions to reduce or eliminate health disparities.

描述（由申请人提供）：卫生与公共服务部最终规则指出，器官分配“不得基于候选人的居住地或上市地点”，但取决于儿童居住的位置，他的中位数等待死者肾脏肾脏移植的时间与14-1313天不同。除了个体因素之外，我们不明白为什么存在这种小儿肾移植的地理差异。该提案的广泛长期目标是通过告知有针对性的干预措施以减少终末期肾脏疾病（ESRD）的移植障碍的差异来推动科学的前进。这项研究将使用新型的地理空间分析方法来表征ESRD Live and Leys sherafate oflantation的儿童的属性，我们将深入了解这些属性如何相互作用以影响对儿科等待名单和移植的访问。使用创新的生态模型，该模型结合了个人，社区级别和机构级别的因素，我们将解散有助于儿童肾脏移植的多种因素。对于AIM 1，我们将使用强大的国家数据来为每个患者的住宅社区获得社区级健康风险评分，并评估社区级健康风险是否影响移植的机会。我们假设居住在健康社区中的儿童健康决定因素不太有利，将会经历更长的时间ESRD，以等待上市和较低的移植概率。 对于AIM 2，我们将研究社区水平的健康风险如何与发生ESR​​D儿童的地理空间接收到移植的地理空间相互作用。我们假设生活在“低风险”社区中的儿童从事件发生的ESRD待员列表和移植可能性增加，而不管对移植中心的地理空间通道如何；尽管对于居住在“高风险”社区的儿童，但较少的地理空间进入移植将为等待上市和移植带来重大障碍。我们将使用患者居住邮政编码与周围移植中心（包括旅行距离和时间）的距离近距离的多个指标来衡量“地理空间访问”。通过检查地理，社区级健康和小儿肾移植的动态相互作用，我们将能够确定应采取干预措施以及在何处进行干预以减少差异。这些结果将为如何提高质量，公平和对所有儿童提供护理机会提供信息。 NIH和NIDDK强调需要进行更严格的研究，以提高对社区对健康行为影响的了解，以及2）开发和测试更有效的干预措施，以减少或消除健康差异。