Reducing disparities in living donor transplant among African Americans

减少非裔美国人活体捐赠者移植方面的差异

• 批准号: 10202568
• 负责人: Kimberly Ruth Jacob Arriola
• 金额: $ 22.93万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10202568
• 关键词: Achievement; Acute; African American; Behavioral; Clinical; Communication; Complement; Cost Savings; Country; Coupled; Data; Dialysis procedure; Donor person; Dose; Education; Educational Background; Educational Intervention; Educational Materials; Educational Status; End stage renal failure; Environment; Evaluation; Family; Friends; Funding; Goals; Graft Survival; Grant; Health Care Costs; Health system; Individual; Intervention; Intervention Studies; Kidney; Kidney Transplantation; Knowledge; Light; Living Donors; Mediating; Modeling; Motivation; National Institute of Diabetes and Digestive and Kidney Diseases; Online Systems; Outcome; Pamphlets; Participant; Pathway interactions; Patients; Process; Provider; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Records; Research; Sampling; Self Efficacy; South Carolina; Southeastern United States; System; Testing; Time; Transplant Recipients; Transplantation; United States; United States Health Resources and Services Administration; Vision; Wait Time; Waiting Lists; behavior change; comparison intervention; disparity reduction; follow up assessment; follow-up; health disparity; hospitalization rates; insight; interest; intervention effect; living kidney donor; online intervention; optimal treatments; primary outcome; programs; racial disparity; recruit; secondary analysis; secondary outcome; skills; statistics; stem; transplant centers; trial design; web site

Abstract For most of the patients in the United States with end stage renal disease (ESRD), kidney transplantation represents the optimal treatment. Moreover, living donor kidney transplantation (LDKT) offers numerous advantages over deceased donor kidney transplant such as better kidney quality, increased short- and long- term graft survival, lower rates of acute rejection, and reduced health care cost. Nevertheless, there are pervasive racial disparities in access to LDKT, with white ESRD patients four times more likely to receive a LDKT than African American ESRD patients. The long-term objective of this program of research is to understand the combined effect of a systems-level intervention that enhances communication between dialysis facility and transplant center clinicians (Transplant Referral EXchange or T-REX) and a culturally-sensitive individual-level educational intervention (web-based Living ACTS: About Choices in Transplantation and Sharing) on racial disparities in access to LDKT. The specific aims of the study are: (a) To develop and refine a web-based version of Living ACTS; (b) To conduct an outcome evaluation of the newly created web-based Living ACTS intervention by comparing the percent of patients with at least one inquiry from a potential living donor among patients who receive Living ACTS compared to those who receive a control website with an embedded educational video; and (c) To conduct a process evaluation of the newly created web-based Living ACTS intervention by adapting commonly used process evaluation constructs (context, reach, dose received, fidelity, and recruitment) for an online environment. We will conduct a randomized controlled trial among a sample of 800 African American ESRD patients in the southeastern United States (ESRD Network 6 in Georgia and South Carolina), the region of the country with the largest proportion of African American ESRD patients on the waiting list. Patients will be randomly assigned to one of two study conditions (intervention or control). Participants at all four collaborating transplant centers will be seen by providers who utilize T-REX, thus allowing us to test the independent effect of individual-level education on a systems-level intervention. The primary outcome is the percent of patients with at least one living donor inquiry. Secondary outcomes will test the effect of the intervention on key constructs of the Information-Motivation-Behavioral Skills model to determine possible mediating pathways. Participants will undergo baseline assessment, access either the intervention or control educational materials, and complete an immediate follow-up assessment. Living donor inquiries will be examined over the subsequent 12 months. The process evaluation will utilize transplant center administrative records, immediate follow-up data from participants, website usage statistics, and study records. It is anticipated that achievement of these aims will yield outcomes with great clinical and public health impact.

抽象的 对于美国大多数患有终末期肾病 (ESRD) 的患者来说，肾移植 代表最佳治疗。此外，活体肾移植（LDKT）提供了许多 与已故供体肾移植相比的优势，例如更好的肾脏质量、增加的短期和长期肾移植 移植物足月存活、急性排斥反应率降低以及医疗费用降低。尽管如此，还是有 在获得 LDKT 方面存在普遍的种族差异，白人 ESRD 患者接受治疗的可能性是其他患者的四倍 LDKT 高于非裔美国 ESRD 患者。该研究计划的长期目标是 了解增强透析之间沟通的系统级干预的综合效果 机构和移植中心的临床医生（移植转介交换或 T-REX）以及具有文化敏感性的人员 个人层面的教育干预（基于网络的 Living ACTS：关于移植和移植的选择） 分享）关于获得 LDKT 的种族差异。研究的具体目标是： (a) 开发和完善 Living ACTS 的网络版本； (b) 对新创建的网络进行成果评价 生活 ACTS 干预，通过比较至少接受过一次潜在生活询问的患者百分比 接受 Living ACTS 的患者与接受对照网站的患者的捐赠者相比 嵌入式教育视频； (c) 对新创建的网络生活进行过程评估 通过采用常用的过程评估结构（背景、范围、接受的剂量、 保真度和招聘）用于在线环境。 我们将对美国 800 名非裔美国 ESRD 患者进行随机对照试验。 美国东南部（乔治亚州和南卡罗来纳州的 ESRD 网络 6），该国的地区 等候名单上非裔美国 ESRD 患者所占比例最大。患者将被随机 分配给两种研究条件之一（干预或对照）。所有四次合作移植的参与者 使用 T-REX 的提供商将看到中心，从而使我们能够测试 T-REX 的独立效果 系统级干预的个体级教育。主要结果是患有以下疾病的患者的百分比 至少进行一次活体捐赠者询问。次要结果将测试干预措施对关键结构的影响 信息-动机-行为技能模型以确定可能的中介途径。参加者 将接受基线评估，获取干预或对照教育材料，并且 立即完成后续评估。活体捐赠者询问将在接下来的 12 年内进行审查 几个月。过程评估将利用移植中心的管理记录、即时后续数据 来自参与者、网站使用统计数据和研究记录。预计这些目标的实现 将产生具有巨大临床和公共卫生影响的结果。