Infections are a frequent cause of hospitalization in persons with end-stage renal disease and the second leading cause of mortality after cardiovascular disease. Although overall hospital admission rates have stabilized in the end-stage renal disease population at approximately two hospitalizations per patient per year, the rate of infection-related hospitalizations has increased 33% between 1994 and 2008. This proposal aims to: 1) identify patient-level and center-level risk factors for infection using the United States Renal Data System (USRDS), 2) examine how different dialysis center policies, practices and procedures correlate with risk of infection-related hospitalization using a nationall administered survey linked with the USRDS, and 3) describe the outcomes of infection-related hospitalization in patients on dialysis using data from the USRDS linked with the Minimum Data Set. The findings from these studies will provide a framework for developing preventive strategies and policies to improve the care of patients on dialysis. My short-term career goals are to examine risk factors and outcomes of infection-related hospitalization so that effective approaches to prevention and intervention can be developed. My long-term career goals are to develop center-level interventions and conduct comparative effectiveness studies that examine the relative impact of different interventions on the risk of infection. These goals will be facilitated by further training in longitudinal and hierarchical biostatistical methods, developmen and use of research survey instruments, the development of interventions and comparative effectiveness research. The proposed research will primarily be conducted at the University of California Davis (UC Davis) with the support of the University of California San Francisco (UCSF). The research and training environment at UC Davis includes the NIH Clinical and Translational Science Center (CTSC);Center for Healthcare Policy and Research;graduate level courses in biostatistics, epidemiology and comparative effectiveness research;research infrastructure for the management of large databases;and an emphasis on experienced researchers mentoring junior faculty. The CTSC has been established to encourage the development of clinical and translational research and to support investigators in their research efforts. UCSF has an established and renowned clinical research infrastructure with a biostatistics and epidemiology core trained in the analysis of the USRDS. Both UC Davis and UCSF have a longstanding history of excellence in patient-oriented research and collaborative research efforts.
To date, research on infection has not examined how patient and dialysis center characteristics interrelate to risk of infection. Understanding how both patient- and center-level characteristics contribute to infection risk is essential to developing effective interventions and reducing the unacceptably high risk of infections in patients on dialysis. The proposed research will enhance our understanding of factors that contribute to the high risk of infection in patients on dialysis and will also examine in-depth the outcomes of these infections.
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