This K08 proposal aims to provide Dr. Eugene Lin, MD, MS, with the protected time, training, mentorship, and research experience to allow him to become an independent health services researcher in kidney diseases. As an academic nephrologist, Dr. Lin focuses his research on health policy issues and efficient care delivery pertaining to kidney diseases and, in particular, dialysis. Home dialysis offers patients independence and improved quality of life, and it is less costly to society. However, many patients choose to switch from home dialysis to in-center dialysis, especially when they do not receive adequate support or when they are not sufficiently prepared. This dropout from home dialysis is costly and a potential loss in patient and societal well- being. Recent dialysis payment reform through the end-stage renal disease (ESRD) Prospective Payment System (PPS) catalyzed an increase in home dialysis use, by making it more profitable relative to in-center dialysis. However, it is unclear if payment reform simultaneously incentivized the recruitment of patients who are more likely to drop out or if it led to the emergence of facilities less equipped to support patients on home dialysis. Additionally, little is known about potential solutions to mitigate home dialysis dropout. To address this knowledge gap, this study aims to: (1) quantify changes in home dialysis dropout due to the ESRD PPS, (2) identify changes in the types of facilities offering home dialysis and changes in the composition of patients receiving home dialysis, and (3) evaluate potential strategies that might decrease home dialysis dropout, including retraining and periods of respite. Dr. Lin will accomplish these research goals by applying econometric techniques to a large claims database and by developing a dynamic simulation model of patients undergoing home dialysis. This proposal is highly likely to make a substantial impact on patient care by potentially changing how facilities manage patients on home dialysis. Studying the impact of payment reform will also help policy makers better understand its effects and will help inform the design and refinement of future policies aimed at improving the provision of home dialysis. To accomplish these aims, Dr. Lin will receive additional training in econometrics and design science, under the guidance of a multi-disciplinary mentorship team. The proposed work and career development plan are realistic and feasible within the award period and will ensure that Dr. Lin develops the skills to compete for R01 funding. In short, this K08 award will provide the training, research experience, and mentorship needed to help Dr. Lin successfully transition into an independent health services researcher.
Patients who receive dialysis at home often drop out and transition to facility-offered dialysis, which constitutes a loss of patient independence and well-being and can be costly to society. This proposal aims to evaluate economic and social determinants of dropout, especially in light of recent dialysis payment reform. The project will also investigate potential ways to reduce dropout, including retraining programs and periods of respite.