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.

项目概要 COVID-19 大流行威胁着肾衰竭患者的健康，因为终末期肾衰竭 疾病 (ESKD) 是大多数肾衰竭患者死亡的危险因素。 每周在门诊透析机构与其他患者一起进行 3 次血液透析治疗。 可能导致不可避免的患者聚集和病毒传播的风险增加。 肾衰竭患者通常有多种合并症，基线死亡率高，并且更有可能 是受到不成比例影响的黑人或西班牙裔、种族/族裔少数群体 ESKD 患者的高住院率也需要一个能够提供支持的医疗保健系统。 门诊透析设施和医院之间的无缝护理协调。 为了降低患者感染 COVID-19 的风险，机构可以实施多项预防措施 措施，包括减少每次血液透析治疗的持续时间、将患者分配到 专门容纳 COVID-19 患者的单独设施或班次，建立额外的 设施内的“隔离”站，为接受家庭透析的患者提供培训和支持，以及 在疗养院而不是门诊透析设施中为疗养院居民提供护理。 一些透析设施已报告实施这些策略，但系统性的国家数据 它们的采用以及与有意义的患者结果的关联尚不清楚。 使用来自所有门诊透析设施的数据以及肾衰竭患者的普查数据 该项目在 2018 年至 2022 年期间进行透析，有三个目标：首先，我们估计的程度。 COVID-19 促使设施层面采用感染控制措施，并检查 我们的工作假设是，与 LDO 相关的设施， 那些位于贫困社区和感染率高的县的人会更多 可能会采取保护措施来应对 COVID-19 的威胁。 设施级感染控制应对措施对 COVID-19 相关和全因住院治疗的有效性 我们的工作假设是感染控制措施导致感染减少。 相关住院率和死亡率，但非 COVID-19 和总体住院率和死亡率 第三，我们估计了透析患者的血液透析疗程受到的影响程度。 我们的工作假设是透析患者入院。 前往 COVID-19 感染率高的县或 COVID-19“热点地区”的医院的经历更大 总体而言，我们的研究自传播以来将产生积极影响。 有关有效应对措施的信息将使其他设施能够采用这些信息，并减少 COVID-19 在这一脆弱的患者群体中传播。