Bethesda, MD 01/20/2020 – The Population Health Management practice of the Medical Technology and Practice Patterns Institute (MTPPI) has been awarded a five-year contract to serve as the exclusive data-coordinating and analytics center for a multi-site research project investigating the barriers to arteriovenous fistula use in black hemodialysis patients. “This large 5-year R01 is a culmination of our work with Dr. Michael Allon and Dr. Timmy Lee at UAB Medicine,” stated Dr. Mae Thamer, Director of Research at MTPPI. “This project will leverage our research expertise in the vascular access arena and mark the beginning of our focus on disparity research in collaboration with the Johns Hopkins Center for Health Disparities Solutions. We look forward to executing on this partnership and furthering collaborative opportunities with this consortium.”
Currently, over 400,000 U.S. end-stage renal disease (ESRD) patients receive hemodialysis (HD) to sustain their lives. Within the ESRD disease state, black patients represent a disproportionate percentage of the prevalent and incident populations. To successfully and efficiently dialyze, ESRD patients must have a reliable conduit to the vasculature (vascular access), which is achieved with either an arteriovenous fistula (AVF) or arteriovenous graft (AVG). The current national consensus vascular access guidelines and recently mandated quality improvement strategies strongly recommend preferential placement of AVFs. Unfortunately, 80% of ESRD patients initiate HD with a central vein catheter (CVC), the worst possible vascular access in terms of patient mortality and adverse outcomes. Racial disparities in the frequency of AVF use between blacks and whites begin at HD initiation and increase over time. This study will investigate the reasons for the lower AVF use among blacks and serve to inform meaningful future, multi-level intervention.
MTPPI will be responsible for determining whether surgical processes of care to achieve and maintain AVF use differ between blacks and whites initiating hemodialysis with a CVC and evaluate the role of system-level factors. MTPPI will also be responsible for conducting a mediational analysis after patient surveys have been conducted and all provider and system level data at the clinical sites has been collected. Once collected, MTPPI’s statistical team will conduct all study analyses and support the development of journal manuscripts and clinical conference presentations. This project will utilize a unique data collection strategy which will combine national USRDS data (which includes all US dialysis patients initiating hemodialysis with a CVC) with detailed prospective data obtained from a large dialysis center. The study will also examine the association between system-level factors—including both patient and dialysis facility organizational measures—and racial differences in AVF outcomes for 3 processes of care
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