Health system outreach to eliminate disparities in living kidney transplants

卫生系统外展活动，消除活体肾移植方面的差异

• 批准号: 10167095
• 负责人: Leigh E Boulware
• 金额: $ 397.45万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-20 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10167095
• 关键词: Address; African American; American; Awareness; Caring; Counseling; Data; Dialysis procedure; Disease Progression; Early identification; Education; Effectiveness; Effectiveness of Interventions; Electronic Health Record; End stage renal failure; Evaluation; Face; Family Physicians; Guidelines; Health Information System; Health system; Healthcare; Human Resources; Incidence; Individual; Information Systems; Intervention; Intervention Studies; Kidney; Kidney Diseases; Kidney Failure; Kidney Transplantation; Knowledge; Laboratories; Lead; Logistics; Measures; Morbidity - disease rate; Outcome; Patients; Physicians; Policy Maker; Population; Process; Race; Randomized; Records; Registries; Resources; Risk; Services; Social Workers; Transplantation; base; comparative effectiveness trial; compare effectiveness; computer generated; contextual factors; design; effective intervention; effectiveness measure; experience; improved; innovation; living kidney donor; metropolitan; mortality; optimal treatments; outreach; outreach program; prediction algorithm; primary outcome; programs; racial and ethnic; racial disparity; racial minority; recruit; rural area; social; transplant centers; treatment as usual

PROJECT SUMMARY Despite their nearly four-fold greater incidence of end stage kidney disease compared to Whites, African Americans have lower rates of early living donor kidney transplantation (LDKT), an optimal treatment for end stage kidney disease. Disparities in receipt of LDKT have worsened over the past decade. At least four critical roadblocks hinder patients’ journey along the path to receiving LDKTs, including their lack of awareness of their need for LDKT; poor knowledge of LDKT and difficulties discussing LDKT with family and physicians; infrequent or sluggish referrals for early transplant evaluations; and difficulty completing the multi-step transplant evaluation process. African Americans may more frequently face these critical roadblocks when compared to others. Rigorously studied interventions simultaneously addressing these critical roadblocks do not exist. Health systems have numerous capabilities (including information and staffing resources) that could be creatively leveraged to address the multiple critical roadblocks to LDKT that contribute to disparities. However, studies quantifying the effectiveness of interventions which harness and coordinate health system resources to mitigate LDKT disparities have not been performed, leaving an evidence gap. We propose to study an innovative intervention, “Health System Surveillance and Outreach,” designed to overcome multiple roadblocks which lead to LDKT disparities. We will conduct a comparative effectiveness trial to quantify the effectiveness of ‘Health System Surveillance and Outreach’ compared to usual care to mitigate race disparities in LDKT. Our study will be conducted within two large health systems in the Southern US, where disparities in kidney disease are extremely prevalent, and where LDKT is most desperately needed. Health System Surveillance and Outreach will integrate a surveillance registry into electronic health information systems to identify all potential candidates for pre-emptive or early LDKT early and equitably by using patients’ laboratory data and a validated computer-generated kidney disease progression risk prediction algorithm. Transplant social workers and coordinators, who are already embedded in transplant teams, will ‘reach out’ to identified potential LDKT candidates to help them address contextual factors (including educational, social, logistical, and navigation needs) that pose roadblocks to LDKT. Our two primary outcomes will measure patients’ initiation and completion of kidney transplant evaluations using health system records. We will also measure the effectiveness of our navigation support on the kidney transplant evaluation process. This study will provide evidence needed to eliminate LDKT disparities in the South and across the nation.

项目摘要 尽管它们的末期肾脏疾病发生了近四倍，但 白人，非洲裔美国人的早期供体肾脏移植（LDKT）的发生率较低， 最佳治疗末期肾脏疾病。 LDKT收到的差异 在过去的十年中，恶化了。至少有四个关键的障碍阻碍了患者的旅程 接受LDKT的途径，包括他们对LDKT的需求缺乏认识；贫穷的 与家人和医生有关LDKT和困难讨论LDKT的知识；罕见或 早期移植评估的转介迟钝；并且很难完成多步 移植评估过程。非裔美国人可能会更经常面对这些关键 与其他人相比，路障。严格研究干预措施 解决这些关键的障碍不存在。卫生系统具有许多功能 （包括信息和人员配备资源）可以创造性地利用以解决 造成差异的LDKT的多个关键障碍。但是，研究量化 利用和协调卫生系统资源的干预措施的有效性 减轻LDKT差异尚未执行，留下证据差距。我们建议 研究一种创新的干预措施，“卫生系统监视和外展”，旨在 克服多个障碍，导致LDKT差异。我们将进行比较 有效性试验，以量化“卫生系统监视和外展的有效性” 与通常的护理相比，可以减轻LDKT中的种族分布。我们的研究将在其中进行 美国南部的两个大型卫生系统，肾脏疾病的分布极为 普遍，最迫切需要LDKT的地方。卫生系统监视和 外联将将监视注册处整合到电子健康信息系统中 通过使用 患者的实验室数据和经过验证的计算机生成的肾脏疾病进展风险 预测算法。移植社会工作者和协调员，他们已经嵌入 移植团队将“接触”以确定潜在的LDKT候选者，以帮助他们解决 摆构的上下文因素（包括教育，社会，物流和导航需求） 通往LDKT的障碍。我们的两个主要结果将衡量患者的主动性和完成 使用卫生系统记录进行肾脏移植评估。我们还将测量 我们导航支持对肾脏移植评估过程的有效性。这项研究 将提供所需的证据，以消除南部和全国各地的LDKT差异。