Processes and Outcomes of Chronic Kidney Disease in the Urban Poor

城市贫困人口慢性肾病的过程和结果

• 批准号: 8704422
• 负责人: Yoshio N. Hall
• 金额: $ 7.73万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-19 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8704422
• 关键词: Accounting; Admission activity; Affect; Age; Albuminuria; Ambulatory Care; American; Americas; Caring; Chronic; Chronic Kidney Failure; Clinical; Cohort Studies; Community Health Networks; Congestive Heart Failure; Data; Destinations; Diabetes Mellitus; Dialysis procedure; Disadvantaged; Disease Progression; Early Intervention; Effectiveness; End stage renal failure; English Language; Enrollment; Ethnic Origin; Evaluation; Event; Glomerular Filtration Rate; Goals; HIV; Health; Health Insurance; Health Personnel; Health system; Healthcare; Heterogeneity; Homelessness; Hospital safety; Hospitalization; Housing; Individual; Information Systems; Kidney; Language; Location; Low Income Population; Low income; Medicaid; Medical; Medical center; Minority Groups; Modeling; Morbidity - disease rate; Nephrology; Not Hispanic or Latino; Outcome; Patients; Performance; Persons; Population; Process; Provider; Public Health; Public Hospitals; Race; Randomized Controlled Trials; Renal function; Reporting; Research; Research Design; Risk; Risk Factors; San Francisco; Site; Societies; Socioeconomic Status; Staging; Substance abuse problem; System; Testing; Underserved Population; Uninsured; United States; Virus Diseases; base; clinical decision-making; cohort; cost; cost effectiveness; design; disability; disorder risk; effective intervention; experience; follow-up; high risk; hospital readmission; improved; instrument; low socioeconomic status; male; medically underserved population; prevent; public health relevance; racial and ethnic; safety net; sex; socioeconomics; tool

DESCRIPTION (provided by applicant): In the United States (US), the rates of end-stage renal disease (ESRD), hospitalization and 30-day hospital readmission differ markedly by age, race-ethnicity, socioeconomic status and site of care. Despite the disproportionate burden of ESRD observed among persons of racial-ethnic minority groups and low-income populations, few US-based studies in chronic kidney disease (CKD) have successfully examined the health processes and outcomes of persons receiving care within public hospitals and safety-net health systems. The primary aims of this proposal are (1) to develop and validate an ESRD risk prediction instrument and compare its performance to existing ESRD risk prediction tools using data from persons with moderate to advanced CKD who received ambulatory care within public health systems; and (2) to estimate rates of, and identify factors associated with, 30-day hospital readmission among persons with moderate to advanced CKD within a large public hospital system. This proposal will utilize a retrospective cohort study design to develop risk prediction tools to enable health providers and health systems to systematically identify persons at highest risk for CKD-related morbidity. Such high-risk patients could receive more intensive surveillance, intervention, and earlier nephrology and transitional care. The long-term objective of this research is to reduce the burden of CKD among traditionally underserved populations using effective interventions that can be used to slow progression and prevent complications of CKD.

描述（由申请人提供）：在美国 (US)，终末期肾病 (ESRD)、住院率和 30 天再入院率因年龄、种族、社会经济状况和护理地点而存在显着差异。尽管在少数族裔群体和低收入人群中观察到 ESRD 负担过高，但美国很少有关于慢性肾病 (CKD) 的研究成功地检查了在公立医院接受护理的人员的健康过程和结果以及安全性-网络卫生系统。该提案的主要目标是 (1) 开发和验证 ESRD 风险预测工具，并使用在公共卫生系统内接受门诊护理的中度至晚期 CKD 患者的数据，将其性能与现有的 ESRD 风险预测工具进行比较； (2) 估计大型公立医院系统内中度至晚期 CKD 患者 30 天再入院率并确定与之相关的因素。该提案将利用回顾性队列研究设计来开发风险预测工具，使卫生服务提供者和卫生系统能够系统地识别 CKD 相关发病风险最高的人群。此类高危患者可以接受更深入的监测、干预以及早期肾病学和过渡护理。这项研究的长期目标是通过有效的干预措施来减缓慢性肾病的进展并预防慢性肾病的并发症，从而减轻传统上服务不足的人群的慢性肾病负担。