Infection Control Measures in Dialysis Facilities after COVID-19: Disparities in Adoption and Impact on Hospitalization and Mortality

COVID-19 后透析设施的感染控制措施：采用差异以及对住院和死亡率的影响

• 批准号: 10193135
• 负责人: AMAL N. TRIVEDI
• 金额: $ 47.95万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10193135
• 关键词: Infection; Control; Measures; Dialysis; Facilities

PROJECT SUMMARY The COVID-19 pandemic threatens the health of patients with kidney failure because end-stage kidney disease (ESKD) is a risk factor for COVID-19 related death. Most patients with kidney failure undergo hemodialysis treatment in an outpatient dialysis facility three times a week alongside other patients. This can result in unavoidable patient clustering and an increased risk of viral transmission. Further, patients with kidney failure often have multiple comorbidities, high baseline rates of mortality, and are more likely to be black or Hispanic, racial/ethnic minority groups that have been disproportionately impacted by the pandemic. High hospitalization rates for ESKD patients also demands a health care system that allows seamless care coordination between the outpatient dialysis facilities and hospitals. In order to mitigate patients' risk of contracting COVID-19, facilities could implement several precautionary measures, including reducing the duration of each hemodialysis treatment session, assigning patients to separate facilities or shifts that specifically accommodate COVID-19 patients, establishing additional “isolation” stations within a facility, offering training and support for patients receiving home dialysis, and providing care to nursing home residents in the nursing home as opposed to an outpatient dialysis facility. Some dialysis facilities have reported implementing these strategies, but systematic national data about their adoption and association with meaningful patient outcomes are not known. Using data from the universe of all outpatient dialysis facilities and a census of patients with kidney failure undergoing dialysis for the period 2018-2022, this project has three aims. First, we estimate the extent to which COVID-19 spurred the facility-level adoption of infection-control practices, and to examine the heterogeneity in adoption across facilities. Our working hypothesis is that facilities affiliated with LDOs, those located in disadvantaged neighborhoods, and those in counties with high infection rates will be more likely to adopt protective measures in response to the threat of COVID-19. Second, we investigate the effectiveness of facility-level infection-control responses on COVID-19 related- and all-cause hospitalization and mortality. Our working hypothesis is that infection control measures resulted in a reduction of infection- related hospitalizations and mortality, but non-COVID-19 and overall hospitalization and mortality rates increased. Third, we estimate the extent to which hemodialysis sessions were impacted for dialysis patients admitted to hospitals in high-COVID-19 counties. Our working hypothesis is that dialysis patients admitted to hospitals in counties with high COVID-19 infection rates or COVID-19 “hotspots” experience greater reductions in dialysis sessions. Overall, our study will have a positive impact since dissemination of information about responses found effective will allow other facilities to adopt them, and reduce COVID-19 transmission in this vulnerable patient population.

项目摘要 COVID-19大流行威胁着肾衰竭患者的健康，因为末期肾脏 疾病（ESKD）是大多数肾衰竭患者的危险因素。 每周与其他患者一起进行门诊透析设施中的血液透析治疗 可能导致不可避免的患者聚类和进一步的病毒传播风险 随着肾脏衰竭通常具有多裂合并症，死亡率高的基准率，并且更可能也很可能 是黑人或西班牙裔，种族/族裔少数群体，受到了受到影响的影响 ESKD患者的大流行还需要 无缝的护理协调在乘场设施和医院。 为了减轻患者患者的Covid-19风险，设施可以实施几种预防措施 措施，包括减少每个血液透析治疗课程的持续时间，将患者分配给 单独的设施或班次，专门针对Accomode Covid-19患者，建立了其他 设施内的“隔离”站，为接受家庭透析和透析的患者提供培训和支持。 为疗养院的养老院居民提供护理，以便在门诊透析设施中提供护理。 一些透析设施报告了实施这些策略，但有关系统的国家数据 他们的采用和与有意义的patcomes的关系尚不清楚。 使用所有门诊透析设施的宇宙数据和肾脏毛毛病患者的普查 在2018 - 2022年期间，透析有三个目标。 19ciD-19刺激了设施级的采用感染控制实践，并检查了您 我们的工作假设是跨设施的异质性。 在处境不利的社区中 我们可能会采取保护性措施，以响应于19的螺纹 设施级感染控制对19相关19相关19和全因医院的有效性 和死亡率。 相关的住院和砂浆，但非卵路19，总体住院和死亡率 增加。 在19个县接受了透析患者的糖尿病。 在199年感染率高或共同的“热点”县的山脉中，经历更大的体验 透析疗法的减少。 有关发现有效响应的信息将使其他设施可以采用它们，并减少Covid-19 在这个脆弱的患者人群中传播。