Quality Dialysis Outcomes and Practice Patterns Study (DOPPS): high-quality care

优质透析结果和实践模式研究 (DOPPS)：高质量护理

• 批准号: 8043289
• 负责人: Francesca Tentori
• 金额: $ 14.57万
• 依托单位: ARBOR RESEARCH COLLABORATIVE FOR HEALTH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-15 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8043289
• 关键词: Academic Medical Centers; Accounting; Achievement; Affect; American; Ancillary Study; Anemia; Attention; Award; Biometry; Blood Vessels; Caregivers; Caring; Case Mixes; Chronic Disease; Chronic Kidney Failure; Clinic; Clinical; Clinical Practice Guideline; Clinical Research; Clinical Trials; Cohort Studies; Collaborations; Communication; Complement; Country; Data; Development Plans; Dialysis patients; Dialysis procedure; Dose; Educational Status; End stage renal failure; Ensure; Environment; Epidemiology; Family; Foundations; Funding; Future; Goals; Health; Hemodialysis; Hemoglobin; Hospitalization; Incentives; Individual; Institution; Interdisciplinary Study; International; Intervention; Italy; Journals; Kidney Failure; Knowledge; Lead; Learning; Life; Maintenance; Master of Science; Measures; Mentored Research Scientist Development Award; Mentors; Mentorship; Monitor; Nephrology; Outcome; Outcome Study; Outcomes Research; Ownership; Patients; Pattern; Peer Review; Performance; Physician Executives; Play; Practice Guidelines; Professional Organizations; Professional Role; Prospective Studies; Provider; Publications; Publishing; Qualifying; Quality Indicator; Quality of Care; Quality of life; Registries; Research; Research Infrastructure; Research Personnel; Research Project Grants; Resources; Rest; Risk; Role; Sampling; Scientist; Secure; Serum Albumin; Services; Societies; Time; Training; Transplant Recipients; United States; United States Dept. of Health and Human Services; Universities; Urea; Work; base; career; career development; clinical epidemiology; clinical practice; cohort; design; efficacy testing; end-stage organ failure; experience; improved; indexing; interest; meetings; member; modifiable risk; mortality; patient oriented; patient oriented research; payment; pressure; programs; prospective; skills; tool

DESCRIPTION (provided by applicant): Candidate: After training as a clinical nephrologist in Milan, Italy, I moved to the United States to pursue a career in outcomes research. Working as the Assistant Medical Director of the Quality Management Department of Dialysis Clinic Inc. (DCI), a large dialysis organization, I developed a keen interest in the delivery of high-quality care as a means to improve outcomes of hemodialysis (HD) patients. In 2007 I joined Arbor Research Collaborative for Health (Arbor Research) as a research scientist and have played an increasingly valuable role as a core member of the research team for the international Dialysis Outcomes and Practice Patterns Study (DOPPS), a 12-country prospective cohort study of HD practices. I also contribute to the newly launched DOPPS Practice Monitor and to the CMS End Stage Renal Disease (ESRD) Quality Measures Project. In my professional roles I have collaborated with leaders in clinical epidemiology in chronic kidney disease (CKD) and ESRD. My research efforts so far have led to 19 peer-reviewed articles (6 as first author) in major journals, 11 invited publications and presentations at professional meetings, including the American Society of Nephrology. Career goals: My long-term professional goal is to become an independently funded investigator and to make important contributions in outcomes research in kidney failure by identifying modifiable clinical practices that may improve the quality of care in HD. My previous experiences have set the foundation for my current research interest. The K01 Award will serve as a spring-board towards this long-term goal by providing me support and protected time to achieve the following immediate goals during the award period: (a) obtain guidance and learn a specific set of skills from each of my outstanding mentors; (b) receive formal graduate- level training in clinical research, especially epidemiology and biostatistics; (c) complete the proposed research project and publish results in major biomedical journals; (d) apply for and secure independent funding. Career development plan: My career development plan will allow me to leverage the strengths of two leading research institutions: Arbor Research in Ann Arbor MI, and Vanderbilt University Medical Center (VUMC) in Nashville TN. Arbor Research will provide me with the opportunity to be mentored by highly-qualified investigators with whom I have an established relationship (Drs. Bruce Robinson, Robert Merion and Brenda Gillespie), a unique research infrastructure, and the ready accessibility of DOPPS data. These resources will be complemented by those at VUMC, including close mentorship by Dr. T. Alp Ikizler, interactions with other patient-oriented researchers and clinicians, and a vibrant scientific environment. I will spend one week per month in Ann Arbor and the rest of the time in Nashville, where I live for family reasons. I have designed a detailed communication strategy that will ensure productive mentorship and collaborations at both institutions. Each member of my outstanding mentorship committee will provide complementary expertise. As the didactic component of my plan, I will obtain a Master of Science in Clinical Investigation by attending the VUMC program, a highly successful training platform which is directed by Dr. Ikizler. Environment: Arbor Research is a not-for-profit organization that leads health outcomes studies in chronic disease and end-stage organ failure, including the DOPPS, the Scientific Registry of Transplant Recipients (SRTR), and numerous studies for the U.S. Department of Health and Human Services. Arbor Research's multidisciplinary, team-based approach is ideally suited to this mentorship program. VUMC is a major university-based research center with a strong track record in supporting the career of junior investigators. The resources at VUMC provide an environment robust in patient-oriented research and a wide range of career development and didactic opportunities. Research plan: In an effort to improve dialysis patient outcomes, increasing attention is paid to the delivery of high-quality care by acting on modifiable factors. Dialysis providers often use the facility proportion of patients meeting practice guidelines (CPG) targets as an indicator of quality of care delivered. Mortality risk of patients treated in dialysis units with greater achievement of quality indicators is lower, and certain quality indicators will soon affect the dialysis reimbursement rate in the US. However, facility achievement of multiple quality indicators is generally rare, and the combination of quality indicators that is associated with the best patient outcomes remains to be identified. Quality DOPPS is an ancillary study to the DOPPS that is designed to identify practices associated with achievement of facility quality indicators and the impact of these indicators on patient outcomes. Using data from a contemporary HD cohort and current CPGs, the combination of key facility quality indicators associated with best patient survival will be identified and incorporated in an aggregate quality index (Aim 1), which could serve as a powerful continuous quality improvement (CQI) tool. Quality DOPPS will also identify clinic practices and services that are associated with greater achievement of key quality indicators (Aim 2). Findings from Quality DOPPS will inform the design of an interventional study to test the efficacy of specific CQI tools and practices on facility quality indicators and patient outcomes, which will be the focus of future applications for independent research funding.

描述（由申请人提供）：候选人：在意大利米兰作为临床肾脏科医生培训后，我搬到美国从事成果研究的职业。我是一个大型透析组织透析临床公司（DCI）质量管理部门的助理医疗总监，我对提供高质量护理的兴趣浓厚，以此作为改善血液透析（HD）患者结果的一种手段。 2007年，我加入了Arbor Research for Health（Arbor Research）作为研究科学家，并作为国际透析结果和实践模式研究（DOPPS）的核心成员扮演了越来越有价值的角色，这是一项12个国家的前瞻性研究HD实践研究。我还为新推出的DOPPS实践监测仪和CMS末期肾脏疾病（ESRD）质量测量项目做出了贡献。在我的职业角色中，我与慢性肾脏疾病（CKD）和ESRD临床流行病学领导者合作。到目前为止，我的研究工作已导致在主要期刊上进行了19篇经过同行评审的文章（有6个作为第一作者），其中11篇在包括美国肾脏病学会在内的专业会议上邀请出版物和演讲。职业目标：我的长期专业目标是成为一名独立资助的研究者，并通过确定可改善的临床实践来提高HD的护理质量，从而在肾衰竭的结果研究中做出重要贡献。我以前的经验为我当前的研究兴趣奠定了基础。 K01奖将通过为我提供支持和保护时间以在奖励期内实现以下即时目标的支持和保护时间：（a）获得指导并从我的每位出色的导师那里学习一组特定技能； （b）接受临床研究的正式研究生培训，尤其是流行病学和生物统计学； （c）完成拟议的研究项目，并在主要的生物医学期刊中发布结果； （d）申请并确保独立资金。职业发展计划：我的职业发展计划将使我能够利用两家领先的研究机构的优势：Ann Arbor MI的Arbor Research和Nashville TN的Vanderbilt大学医学中心（VUMC）。 Arbor Research将为我提供有机会由我与之建立关系的高度合格的研究人员（Bruce Robinson博士，Robert Merion和Brenda Gillespie博士），一个独特的研究基础设施以及DOPPS数据的现成可访问性。这些资源将由VUMC的人们补充，包括T. Alp Ikizler博士的密切指导，与其他面向患者的研究人员和临床医生的互动以及充满活力的科学环境。我每月在安阿伯（Ann Arbor）和纳什维尔（Nashville）的剩余时间里度过一个星期，我出于家庭原因居住。我设计了一种详细的沟通策略，可以确保两个机构的富有成效的指导和合作。我杰出的指导委员会的每个成员都将提供互补的专业知识。作为我计划的教学部分，我将通过参加Ikizler博士执导的非常成功的培训平台VUMC计划，获得临床研究的科学硕士学位。环境：Arbor Research是一个非营利组织，领导慢性疾病和终阶段器官衰竭的健康结果，包括DOPPS，移植受助人科学注册中心（SRTR），以及美国卫生与公共服务部的众多研究。 Arbor Research的多学科，基于团队的方法非常适合该指导计划。 VUMC是一个主要的大学研究中心，在支持初级调查员的职业方面具有良好的往绩。 VUMC的资源在面向患者的研究以及广泛的职业发展和教学机会方面为环境提供了强大的环境。研究计划：为了改善透析患者的结局，通过对可修改因素作用，将越来越多的关注对提供高质量护理的关注。透析提供者通常使用符合实践指南（CPG）目标的患者的设施比例作为提供护理质量的指标。在透析单位接受治疗的患者的死亡率风险较高，质量指标的实现较低，某些质量指标将很快影响美国的透析报销率。但是，设施实现多种质量指标通常很少，并且与最佳患者结局相关的质量指标的组合还有待确定。优质的DOPPS是对DOPP的辅助研究，旨在确定与设施质量指标相关的实践以及这些指标对患者预后的影响。使用当代高清队列和当前CPG的数据，将确定与最佳患者生存相关的关键设施质量指标的组合，并将其纳入汇总质量指数（AIM 1），这可以用作强大的持续质量改进（CQI）工具。优质的DOPP还将确定与更大的关键质量指标实现相关的诊所实践和服务（AIM 2）。质量DOPPS的发现将为介入研究的设计提供信息，以测试特定的CQI工具和实践对设施质量指标和患者结果的功效，这将是未来独立研究资金应用程序的重点。