- Title Information
- Title
- Equity in Policy and Care Delivery for People with Kidney Disease
- Type of Resource (primo)
- dissertations
- Name:
Personal
- Name Part
- Thorsness, Rebecca
- Role
- Role Term:
Text
- creator
- Name:
Personal
- Name Part
- Trivedi, Amal
- Role
- Role Term:
Text
- Advisor
- Name:
Personal
- Name Part
- Mor, Vincent
- Role
- Role Term:
Text
- Reader
- Name:
Personal
- Name Part
- Rahman, Momotazur
- Role
- Role Term:
Text
- Reader
- Name:
Personal
- Name Part
- Wang, Virginia
- Role
- Role Term:
Text
- Reader
- Name:
Corporate
- Name Part
- Brown University. Department of Health Services, Policy and Practice
- Role
- Role Term:
Text
- sponsor
- Origin Information
- Copyright Date
- 2021
- Physical Description
- Extent
- xiv, 92 p.
- digitalOrigin
- born digital
- Note:
thesis
- Thesis (Ph. D.)--Brown University, 2021
- Genre (aat)
- theses
- Abstract
- Chronic kidney disease (CKD), which affects 15% of US adults and one third of individuals over the age of 65, is a severe chronic condition with high morbidity, mortality, and health system spending. Annually, nearly 125,000 individuals develop kidney failure, which requires treatment with dialysis or kidney transplantation for survival, and over 725,000 Americans are living with kidney failure. In recognition of this large burden of disease, the Centers for Medicare & Medicaid Services (CMS) has implemented a number of quality improvement and cost containment initiatives for dialysis care. Despite these initiatives, large racial and socioeconomic disparities persist in kidney failure incidence, access to care, and outcomes, which have been further exposed by the COVID-19 pandemic. This dissertation focuses on some of the inequities people with kidney disease – and especially racial and ethnic minority patients – face as they navigate the U.S. health care system. The first chapter investigates the role of modifiable health system factors, including insurance coverage type and receipt of pre-dialysis nephrology care, and geographic and neighborhood factors as mediators of large racial/ethnic disparities in receiving hemodialysis at a high-quality dialysis facility, finding that proximity and neighborhood factors play the largest role. The second chapter explores how dialysis facilities that serve patients with high social risk, such as exposure to racism and poverty, may perform in CMS’ randomized ESRD Treatment Choices alternative payment model that launched in 2021, finding facilities that serve larger shares of such patients are likely to be disproportionately penalized. Finally, driven by the impact of the COVID-19 pandemic on vulnerable populations, the third chapter focuses on nursing home residents with CKD who were infected with SARS-CoV-2, the virus that causes COVID-19. It finds that increasing CKD stage is independently associated with higher risk of death following SARS-CoV-2 infection. Taken together, these chapters demonstrate how institutionalized and systemic racism operate both at the person level and at the neighborhood level to create and sustain racial/ethnic disparities in kidney disease care and outcomes.
- Subject
- Topic
- chronic kidney disease
- Subject
- Topic
- health disparities
- Subject (fast)
(authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/00892536")
- Topic
- Dialysis
- Subject (fast)
(authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/00952806")
- Topic
- Health and race
- Subject
- Topic
- health services research
- Subject
- Topic
- COVID-19
- Subject (fast)
(authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/00860126")
- Topic
- Chronic renal failure
- Language
- Language Term (ISO639-2B)
- English
- Record Information
- Record Content Source (marcorg)
- RPB
- Record Creation Date
(encoding="iso8601")
- 20211004