PDF(Pubmed)
Abstract：
UNASSIGNED: Health system leaders aim to increase access to kidney transplantation in part by encouraging nephrologists to refer more patients for transplant evaluation. Little is known about nephrologists\' referral decisions and whether nephrologists with older training vintage weigh patient criteria differently (e.g., more restrictively).
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.
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.
摘要：
卫生系统领导者的目标是通过鼓励肾脏病学家推荐更多患者进行移植评估来增加肾脏移植的机会。对肾脏病学家的转诊决定以及接受过老式训练的肾脏病学家对患者标准的权衡是否有所不同(例如，更具限制性)。
■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。
■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。
