Breaking down care process and patient-level barriers to arteriovenous access creation prior to hemodialysis initiation

在开始血液透析之前打破护理流程和患者层面建立动静脉通路的障碍

• 批准号: 9763553
• 负责人: Leigh E Boulware
• 金额: $ 20.21万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9763553
• 关键词: Address; Advocate; Affect; Appointment; Award; Belief; Blood Vessels; Cannulations; Caregivers; Caring; Catheters; Central Vein; Chronic Kidney Failure; Clinical; Clinical Research; Clinical Trials; Comorbidity; Consensus; Data; Dialysis procedure; Education; Effectiveness; Electronic Health Record; Evaluation; Fistula; Focus Groups; Fright; Funding; Health Personnel; Health system; Healthcare; Healthcare Systems; Hemodialysis; Hospitalization; Individual; Intervention; Intervention Studies; Interview; Investigation; Kidney Diseases; Knowledge; Maintenance; Medical; Methods; Morbidity - disease rate; Operative Surgical Procedures; Outcome; Pain; Patient Care; Patient-Focused Outcomes; Patients; Patterns of Care; Perception; Pilot Projects; Process; Provider; Qualitative Research; Quality of life; Research; Research Infrastructure; Research Methodology; Research Project Grants; Self Efficacy; Testing; Time; Time Factors; United States; United States Centers for Medicare and Medicaid Services; Veins; Venous; Wait Time; base; effective intervention; improved; improved outcome; intervention program; mortality; novel; patient-level barriers; peer support; programs; success; therapy design; time interval

PROJECT SUMMARY/ ABSTRACT Vascular access is one of the most challenging and expensive aspects of hemodialysis care. Use of an arteriovenous (AV) access (fistula or graft) is associated with improved quality of life and lower hospitalization and mortality rates. However, <20% of individuals in the US start hemodialysis with an AV access. Most prior efforts to improve AV access rates have focused on AV access creation after dialysis initiation. To date, few efforts to identify and address key barriers to AV access creation prior to dialysis initiation have been undertaken. Low rates of AV access creation may be attributable to a range of patient (e.g., knowledge, beliefs, fears, comorbidity), provider (e.g., knowledge, beliefs, practice patterns), and care process (e.g., fragmentation, long wait times) factors. Care process-based interventions have demonstrated only modest improvements in preemptive AV access creation, suggesting that such strategies on their own are not enough. Patient concerns such as fear, dialysis reluctance, and worries about body disfigurement and cannulation pain may limit the success of care process-based interventions. However, interventions that target both care process and patient-level barriers may improve AV access creation rates. To identify and break-down patient and care process barriers to AV access creation prior to dialysis initiation, we propose to: Aim 1) identify patients’, caregivers’ and health care providers’ perceptions of common barriers to AV access creation prior to dialysis initiation using qualitative research methods, and Aim 2) characterize the associations of care process factors and vascular access type at dialysis initiation using data from a large health care system. In Aim 3, we will conduct a pilot test of a novel intervention targeting key patient and care process barriers to pre-dialysis AV access creation to study intervention feasibility and potential to yield AV access use improvements. To accomplish these aims, we will leverage an existing chronic kidney disease care navigator program in a large health system and research infrastructure supported by a PCORI award. The findings of this research will lay the groundwork for a subsequent R01-equivalent application to fund a clinical trial to evaluate the effect of a patient and care process-focused AV access intervention on AV access use rates, quality of life and other clinical outcomes among individuals initiating hemodialysis in the US.

项目摘要/摘要 血管通道是血液透析护理中最挑战和昂贵的方面之一。使用 动静脉（AV）进入（瘘管或等级）与改善的生活质量和较低的住院关系有关 和死亡率。但是，在美国，<20％的人以AV访问开始血液透析。大多数 提高AV访问率的努力集中在透析计划后的AV访问创建上。迄今为止，很少 努力在透析计划之前识别和解决AV访问创建的关键障碍 进行。较低的AV访问创建率可能归因于一系列患者（例如，知识， 信念，恐惧，合并症），提供者（例如，知道，信念，实践模式）和护理过程（例如， 分裂，等待时间长）。基于护理过程的干预措施仅证明 改进先发制人的AV访问创建，这表明这些策略本身还不够。 患者的担忧，例如恐惧，透析不情愿以及有关身体毁容和插管疼痛的奇迹 可能会限制基于护理过程的干预措施的成功。但是，针对两个护理的干预措施 过程和患者级别的障碍可以提高AV访问率。识别和分解病人 和护理过程障碍在透析计划之前，我们建议：目标1）确定 患者，护理人员和医疗保健提供者对AV访问创建的常见障碍的看法 使用定性研究方法的透析计划，目标2）表征护理过程的关联 使用大型医疗保健系统的数据，透析计划的因素和血管通道类型。在AIM 3中，我们 将对针对关键患者的新干预措施进行试验测试，并进行护理过程障碍 访问创建以研究干预可行性和产生AV访问使用改进的潜力。到 完成这些目标，我们将利用大型现有的慢性肾脏疾病护理导航器计划 PCORI奖支持的卫生系统和研究基础设施。这项研究的发现将提出 随后的R01等效应用资助临床试验以评估A的影响的基础 患者和以护理过程为中心的AV访问访问访问率，生活质量和其他 个体的临床结果在美国引发了血液透析。

项目成果

Stakeholder-Guided Development of Dialysis Vascular Access Education Materials.

利益相关者指导的透析血管通路教育材料的开发。

• DOI: 10.34067/kid.0002382021
• 发表时间: 2021
• 期刊: Kidney360
• 作者: Dorough,Adeline;Narendra,JuliaH;Wilkie,Caroline;Hegde,Akhil;Swain,Kawan;Chang,EmilyH;Oliver,Terence;Flythe,JenniferE
• 通讯作者: Flythe,JenniferE

Targeting Patient and Health System Barriers To Improve Rates of Hemodialysis Initiation with an Arteriovenous Access.

针对患者和卫生系统障碍，通过动静脉通路提高血液透析的启动率。

• DOI: 10.34067/kid.0007812020
• 发表时间: 2021
• 期刊: Kidney360
• 作者: Flythe,JenniferE;Narendra,JuliaH;Yule,Christina;Manivannan,Surya;Murphy,Shannon;Lee,Shoou-YihD;Strigo,TaraS;Peskoe,Sarah;Pendergast,JaneF;Boulware,LEbony;Green,JamieA
• 通讯作者: Green,JamieA