END-STAGE LIVER DISEASE/PREVALENCE & TREATMENT VARIATION
Principal Investigator: C L Bryce
Abstract: DESCRIPTION (adapted from the application) The primary purpose of this proposal is to provide the applicant with means and structure for achieving two goals. The immediate goal is to evaluate the effect of gender, race and income on access to liver transplant services. The long-term goal is to gain independence as a health services researcher by developing methodological expertise in decision sciences and multivariate statistical modeling and research expertise in organ transplantation and health policy evaluation. The applicant will obtain further instruction in computer simulation, geographic information systems, and advanced statistical analysis; in addition, she will receive clinical education to better understand the liver transplantation process and overall delivery of patient care. This training will be provided through formal coursework, directed readings, seminars and conferences, a clinical preceptorship, and research. Most activities will take place at the University of Pittsburgh's School of Medicine, Graduate School of Public Health, and Center for Research on Health Care. The applicant's research project evaluates the role of gender, race, and income in determining access to liver transplantation and explaining variation in liver transplant rates. To date, most studies on access to transplantation have focused on renal transplant services; few researchers have studied hepatic transplantation because of serious data limitations. Whereas the federal government maintains a comprehensive database of persons with renal disease from the time they receive dialysis, there is no centralized, population-based registry for persons with end-stage liver disease (ESLD). Most information on ESLD patients is collected on liver transplant candidates by the United Network for Organ Sharing. The hypothesis of this project is that demographic and economic factors significantly affect early access to transplant services, namely referral rates to transplant centers and listing rates by transplant centers. To address this issue, better information is needed. Therefore, the project will satisfy two aims: (1) develop and validate a population-based methodology for identifying and tracking a cohort of "transplant potential" patients with ESLD; and (2) estimate the effect of gender, race and income on movement through the transplantation process. This project will collect new information on patients with ESLD and combine it with existing data resources made available through The Optimal Timing of Liver Transplantation Project (AHCPR, R01 HS09694-02).
Funding Period: 2000-09-15 - 2006-08-31
more information: NIH RePORT
- Do incentives matter? Providing benefits to families of organ donorsC L Bryce
Department of Medicine, University of Pittsburgh, Pennsylvania, USA
Am J Transplant 5:2999-3008. 2005..While benefits appear to be favored, their true impact can only be assessed through pilot programs...
- Differences in access to liver transplantation: disease severity, waiting time, and transplantation center volumeJawad Ahmad
Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
Ann Intern Med 146:707-13. 2007..Allocation based on MELD scores should ensure that sicker patients receive transplants first regardless of transplantation center volume...
- Sociodemographic differences in early access to liver transplantation servicesC L Bryce
Division of General Internal Medicine, Department of Medicine, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
Am J Transplant 9:2092-101. 2009..For early management and treatment decisions of patients with ESLD to be better understood, more comprehensive data concerning referral and listing practices are needed...