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如何利用实施科学在肾脏病护理服务中实现公平性。

How to Leverage Implementation Science to Achieve Equity in Nephrology Care Delivery.

作者信息

Reddy Yuvaram N V, Ashcraft Laura Ellen, Mendu Mallika L

机构信息

Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.

Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

出版信息

Am J Kidney Dis. 2025 Jun 21. doi: 10.1053/j.ajkd.2025.03.029.

Abstract

There are several evidence-based practices within nephrology that have the potential to meaningfully improve patient outcomes and mitigate disparities. However, these practices are inconsistently implemented in routine care, contributing to low-quality care, persistent health disparities, and high healthcare costs. To address these care gaps quickly, nephrology would benefit from leveraging implementation science: a multidisciplinary field that seeks to close the gap between evidence and practice by examining the optimal approach to help individuals, groups, organizations, and communities implement evidence-based interventions in real-world settings. This Perspective is designed to provide an overview of the field of implementation science and summarize how to apply implementation science in nephrology to address health disparities. To illustrate how to leverage implementation science for health equity, we also showcase two case examples focused on 1) addressing disparities in the use of sodium/glucose cotransporter-2 inhibitors (SGLT2 inhibitors) to slow the progression of chronic kidney disease, and 2) increasing equitable access to home dialysis for people with kidney failure.

摘要

肾脏病学领域有几种基于证据的实践方法,有潜力显著改善患者治疗效果并减少差异。然而,这些实践方法在常规护理中实施不一致,导致护理质量低下、健康差异持续存在以及医疗成本高昂。为了迅速弥补这些护理差距,肾脏病学将受益于利用实施科学:这是一个多学科领域,旨在通过研究帮助个人、群体、组织和社区在现实环境中实施基于证据的干预措施的最佳方法,缩小证据与实践之间的差距。本观点文章旨在概述实施科学领域,并总结如何在肾脏病学中应用实施科学以解决健康差异问题。为了说明如何利用实施科学促进健康公平,我们还展示了两个案例,重点关注:1)解决钠/葡萄糖协同转运蛋白2抑制剂(SGLT2抑制剂)使用方面的差异,以减缓慢性肾脏病的进展;2)增加肾衰竭患者公平获得家庭透析的机会。

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