Identifying determinants of access to the early steps of liver transplant in the Southeast

确定东南部获得肝移植早期步骤的决定因素

• 批准号: 10644293
• 负责人: Katie Ross-Driscoll
• 金额: --
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-20 至 2023-08-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10644293
• 关键词: Affect; Age; Alabama; Area; Ascites; Black Populations; Black race; Caregivers; Caring; Catchment Area; Cessation of life; Characteristics; Cirrhosis; Clinic; Clinical; Collaborations; Communities; Complex; County; Data; Development; Disparity; Eligibility Determination; Encephalopathies; Epidemiologist; Epidemiology; Equity; Evaluation; Exposure to; Funding; Future; Gender; Goals; Grant; Health Services Research; Hemorrhage; Hepatology; Improve Access; Intervention; Interview; Knowledge; Literature; Liver; Low income; Medicaid; Medical; Mentored Research Scientist Development Award; Mentors; Methodology; Methods; Monitor; Needs Assessment; Not Hispanic or Latino; Outcome; Patient Representative; Patients; Persons; Population; Poverty; Prevalence; Process; Provider; Public Health; Qualitative Research; Race; Research; Research Methodology; Research Support; Resources; Retrospective cohort; Role; South Carolina; Southeastern United States; Structure; Target Populations; Tennessee; Testing; Training; Training Support; Translating; Transplant Recipients; Transplantation; United Network for Organ Sharing; United States; Universities; Waiting Lists; Work; access disparities; age stratification; career; curative treatments; differences in access; disease diagnosis; end stage liver disease; experience; geographic difference; geographic disparity; high risk; liver transplantation; medical specialties; mortality; multidisciplinary; post-transplant; psychosocial; racial disparity; research and development; rural area; rural dwellers; rurality; skills; social; social health determinants; socioeconomic disparity; spatial epidemiology; therapy development; transplant centers

Project Summary / Abstract Cirrhosis is a major public health problem in the United States, affecting approximately 4.5 million people with increased prevalence among persons living in poverty and insured by Medicaid. Decompensated cirrhosis, also called end-stage liver disease (ESLD), occurs when patients begin to experience major complications of cirrhosis, including ascites, variceal bleeding, and encephalopathy, with ~200,000 incident cases and 50,000 deaths in the U.S. each year. For patients with ESLD, liver transplant is the only curative treatment option. In 2021, there were approximately 9,000 liver transplants in the U.S. Transplantation is a complex, multistep process that begins at ESLD diagnosis and requires referral to a highly specialized transplant center. This is followed by completion of an intense, holistic medical and psychosocial evaluation process, and, if selected, being placed on the national waiting list for a deceased donor liver. Once patients are waitlisted, they are surveilled by the United Network for Organ Sharing (UNOS), which monitors equity in access to transplantation for patients on the deceased donor waiting list in addition to post-transplant outcomes. While access to liver transplant once waitlisted is relatively equitable, there are racial, socioeconomic, and geographic disparities in waitlisting. Because of data limitations, potential disparities in earlier steps to liver transplant (i.e. referral and evaluation) that may lead to observed differences in waitlisting remain unknown. Using data from two liver transplant centers serving a 108-county region in Georgia, Alabama, Tennessee and South Carolina served by Emory and Piedmont (Atlanta catchment area), combined with patient and provider interviews, the proposed application will identify key factors that influence access to liver transplant referral and evaluation for ESLD patients in the Southeast. This work will inform a future R01 application to develop and test an intervention to increase equity in access to the early steps of liver transplant in this region. The mentoring team, Drs. Rachel Patzer (primary mentor), Dio Kavalieratos (co-mentor) and Raymond Lynch (co-mentor), represent a combined wealth of expertise in transplant epidemiology, clinical liver transplantation, health services research, and qualitative and mixed methods research. Through the training provided by this K01, Dr. Ross-Driscoll will obtain additional knowledge of clinical aspects of liver transplantation, and methodological skills in spatial epidemiology, qualitative research and intervention development. The combination of research and training support provided by this K01 award will allow her to build on her previous experience in liver transplantation, epidemiology, and health services research to become an expert in the field of liver transplant access.

项目概要/摘要 肝硬化是美国的一个主要公共卫生问题，影响着大约 450 万人。 生活贫困并接受医疗补助的人的患病率增加。失代偿性肝硬化， 也称为终末期肝病（ESLD），当患者开始出现主要并发症时发生 肝硬化，包括腹水、静脉曲张出血和脑病，约有 200,000 例发病病例和 50,000 例 美国每年都有死亡人数。对于ESLD患者来说，肝移植是唯一的治疗选择。在 到 2021 年，美国约有 9,000 例肝脏移植手术。移植是一个复杂的、多步骤的过程 该过程从 ESLD 诊断开始，需要转诊至高度专业化的移植中心。这是 随后完成密集、全面的医学和社会心理评估过程，并且，如果选择的话， 被列入已故捐献肝脏的国家等待名单上。一旦患者被列入候补名单，他们就会 接受器官共享联合网络 (UNOS) 的监督，该网络负责监测移植机会的公平性 除了移植后结果之外，还适用于已故捐赠者等待名单上的患者。在进入肝脏的同时 一旦列入候补名单，移植就相对公平，但移植中存在种族、社会经济和地理差异 等候名单。由于数据限制，肝移植的早期步骤（即转诊和转诊）存在潜在差异。 评估）可能导致候补名单中观察到的差异仍然未知。使用来自两个肝脏的数据 移植中心为佐治亚州、阿拉巴马州、田纳西州和南卡罗来纳州的 108 个县提供服务 埃默里大学和皮埃蒙特大学（亚特兰大学区），结合患者和医疗服务提供者的访谈，建议 应用程序将确定影响肝移植转诊和 ESLD 评估的关键因素 东南部的患者。这项工作将为未来的 R01 应用程序提供信息，以开发和测试干预措施 增加该地区获得肝移植早期步骤的公平性。指导团队，博士。雷切尔 Patzer（主要导师）、Dio Kavalieratos（联合导师）和 Raymond Lynch（联合导师）代表了联合导师 在移植流行病学、临床肝移植​​、卫生服务研究和 定性和混合方法研究。通过本 K01 提供的培训，Ross-Driscoll 博士将 获得肝移植临床方面的更多知识以及空间方面的方法技能 流行病学、定性研究和干预措施开发。研究与培训相结合 K01 奖项提供的支持将使她能够在以前的肝移植经验的基础上继续发展， 流行病学和卫生服务研究，成为肝移植领域的专家。