UNASSIGNED: Using a novel, iteratively validated survey of US-based nephrologists, we examined how nephrologists assess adult patients\' suitability for transplant, focusing on established, important criteria: 7 clinical (e.g., overweight) and 7 psychosocial (e.g., insurance). We quantified variation in nephrologist restrictiveness-proportion of criteria interpreted as absolute or partial contraindications versus minor or negligible concerns-and tested associations between restrictiveness and nephrologist age (proxy for training vintage) in logistic regression models, controlling for nephrologist-level and practice-level factors.
UNASSIGNED: Of 144 nephrologists invited, 42 survey respondents (29% response rate) were 85% male and 54% non-Hispanic White, with mean age 52 years, and 67% spent ≥1 day/wk in outpatient dialysis facilities. Nephrologists interpreted patient criteria inconsistently; consistency was lower for psychosocial criteria (intraclass correlation coefficient: 0.28) than for clinical criteria (intraclass correlation coefficient: 0.43; P < 0.01). With each additional 10 years of age, nephrologists\' odds of interpreting criteria restrictively (top tertile) doubled (adjusted odds ratio [aOR] 1.96; 95% confidence interval [CI]: 0.95-4.07), with marginal statistical significance. This relationship was significant when interpreting psychosocial criteria (aOR: 3.18; 95% CI: 1.16-8.71) but not when interpreting clinical criteria (aOR: 1.12; 95% CI: 0.52-2.38).
UNASSIGNED: Nephrologists interpret evaluation criteria variably when assessing patient suitability for transplant. Guideline-based educational interventions could influence nephrologists\' referral decision-making differentially by age.
■使用小说,对美国肾脏病学家的迭代验证调查,我们检查了肾脏病学家如何评估成年患者是否适合移植,专注于已建立的,重要标准:7临床(例如,超重)和7种社会心理(例如,保险)。我们量化了肾脏科医师限制性的变化-被解释为绝对或部分禁忌症的标准的比例与次要或可忽略的担忧-并在逻辑回归模型中测试了限制性和肾脏科医师年龄(训练年份的代理)之间的关联。控制肾病医师水平和实践水平的因素。
■在邀请的144名肾脏病学家中,42名受访者(29%的应答率)为85%的男性和54%的非西班牙裔白人,平均年龄52岁,67%在门诊透析设施中花费≥1天/周。肾脏科医师对患者标准的解释不一致;心理社会标准(组内相关系数:0.28)的一致性低于临床标准(组内相关系数:0.43;P<0.01)。每增加10岁,肾脏科医师限制性解释标准的几率(最高三分位数)增加了一倍(调整后的优势比[aOR]1.96;95%置信区间[CI]:0.95-4.07),具有边际统计意义。在解释社会心理标准时(aOR:3.18;95%CI:1.16-8.71),但在解释临床标准时(aOR:1.12;95%CI:0.52-2.38),这种关系是显着的。
■肾脏科医师在评估患者是否适合移植时,会对评估标准进行不同的解释。基于指南的教育干预可能会影响肾病学家的转诊决策。