Addressing social adversity to improve outcomes among children undergoing liver transplant: the role for a health advocate on the transplant team

解决社会逆境以改善接受肝移植的儿童的预后：移植团队中健康倡导者的作用

• 批准号: 10427960
• 负责人: Sharad Wadhwani
• 金额: $ 19.62万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10427960
• 关键词: Address; Adherence; Advocate; Award; Behavior; Blood Glucose; California; Caregivers; Caring; Cessation of life; Characteristics; Child; Child Care; Childhood; Childhood diabetes; Chronic Disease; Clinic; Clinical; Clinical Trials Design; Collaborations; Communication; Communities; Complex; Data; Development Plans; Documentation; Economics; Enrollment; Ensure; Environment; Ethnography; Family; Family Physicians; Foundations; Funding; Future; Goals; Graft Survival; Health; Health Services; Health education; Health system; Hepatology; Household; Immunosuppression; Individual; Intervention; Interview; Knowledge; Life; Link; Malignant Neoplasms; Measurement; Measures; Medical; Mental Health; Mentored Patient-Oriented Research Career Development Award; Methodology; Methods; Modeling; Morbidity - disease rate; Motivation; Multi-Institutional Clinical Trial; Multicenter Studies; National Institute of Diabetes and Digestive and Kidney Diseases; Neighborhoods; Nurses; Outcome; Outcome Measure; Parents; Patient Care; Patients; Pediatrics; Persons; Pharmaceutical Preparations; Population; Practice Management; Primary Health Care; Procedures; Process; Prospective cohort; Provider; Psychosocial Assessment and Care; Public Health; Publishing; Reach Effectiveness Adoption Implementation and Maintenance; Regimen; Registries; Reporting; Research; Research Design; Research Infrastructure; Research Personnel; Research Support; Resources; Risk; Risk Factors; Role; San Francisco; Savings; Self Management; Social Workers; Social isolation; Social support; Societies; Structure; Supervision; Survey Methodology; Surveys; Testing; Time; Training; Transplantation; Universities; Vision; Visit; adverse outcome; blood glucose regulation; career development; cohort; comorbidity; deprivation; design; efficacious intervention; efficacy testing; end stage liver disease; food insecurity; graft failure; health disparity; health literacy; high risk; implementation evaluation; implementation science; improved; improved outcome; insight; intervention delivery; liver transplantation; medication compliance; member; multidisciplinary; novel; outcome prediction; post-transplant; primary outcome; professor; prospective; recruit; satisfaction; skills; social; social adversity; social health determinants; socioeconomics; stakeholder perspectives; theories; transplant centers; transplant registry; virtual

PROJECT SUMMARY . Pediatric liver transplantation is a life-saving procedure for children with end-stage liver disease, yet long-term outcomes remain sub-optimal. Children facing social adversity, and those from socioeconomically deprived backgrounds have increased risk of graft failure and death following transplant. Disparities in post-transplant outcomes are well-known, yet the field has thus far been unable to overcome them. In contrast, pediatric primary care is rapidly evolving to develop assessment of specific social risk factors and integrate efficacious interventions to address material economic hardships (e.g., food insecurity), poor health literacy, caregiver mental health, social isolation, and neighborhood environment. One potential strategy, utilized in other fields, is to incorporate Health Advocates (team members who help patients/families address social risks) into the clinical team. To adapt a Health Advocate intervention to the needs of children undergoing liver transplantation, a more nuanced understanding of which children are at highest risk, and how a health advocate could integrate within the transplant team are needed. To that end, this study will leverage Dr. Wadhwani’s ongoing KL2 funded, multi-center prospective cohort (SOCIAL-Tx) across 8 U.S. transplant centers to achieve the following Aims: (1) Characterize the association between social risks at the time of transplant with adverse outcomes at 1 and 3 years after transplant; (2) Use multi-stakeholder qualitative interviews (patients/families, physicians, nurses, social workers) to characterize barriers and facilitators to optimal transplant care for patients/families with social risks; (3) Assess feasibility of integrating a health advocate into a liver transplant team and pilot a single-center study exploring whether targeted social support improves post-transplant outcomes. These Aims will provide the necessary preliminary data for a future clustered, pragmatic multi-center RCT testing this Health Advocate intervention. Dr. Wadhwani is an Assistant Professor of Pediatrics at the University of California, San Francisco. Building upon a strong foundation of research support, this K23 award will establish him as an independent health services researcher pioneering research at the intersection of pediatric hepatology, transplantation, and social determinants of health. Under the direct supervision of a multidisciplinary team of leaders in liver transplant/multi-center cohort building (Jennifer Lai), pediatric hepatology, and multi-center clinical trial design (John Bucuvalas), social care integration into health systems (Laura Gottlieb), and qualitative and implementation science methods (Courtney Lyles), Dr. Wadhwani will execute a detailed career development plan to achieve 4 training goals: (1) Pioneer a research niche integrating social and medical care for children undergoing liver transplantation, (2) Develop expertise in social adversity measurement and assessment, (3) Acquire skills necessary to develop, test, and implement health system interventions (e.g., multi-center prospective mixed-methodology, survey methods, in-depth interviewing, and ethnography), and (4) Develop skills in multi-center study design.

项目摘要。 小儿肝移植是终末期肝病儿童的救生程序，但长期 结果仍然是最佳的。面临社交广告的孩子以及社会经济被剥夺的孩子 背景具有移植后移植失败和死亡的风险增加。移植后的差异 结果是众所周知的，但到目前为止，该领域无法克服它们。相反，小儿 初级保健正在迅速发展以制定特定社会风险因素的评估和综合有效的评估 解决物质经济困难的干预措施（例如粮食不安全），健康素养差，照料者 心理健康，社会隔离和邻里环境。在其他领域使用的一种潜在策略是 将健康倡导者（帮助患者/家庭解决社会风险解决的团队成员）纳入 临床团队。为了适应健康倡导干预措施，适应接受肝移植的儿童的需求， 对哪些孩子处于最高风险以及健康倡导者如何整合的更细微的了解 需要在移植团队中。为此，这项研究将利用Wadhwani博士正在进行的KL2 在美国8个移植中心中资助的，多中心的潜在队列（Social-TX），以实现以下 目的：（1）表征移植时社会风险与不良后果的关联 移植后1和3年； （2）使用多利益相关者定性访谈（患者/家庭，医生， 护士，社会工作者）表征障碍和促进者为患者/家庭的最佳移植护理 有社会风险； （3）评估将健康倡导者整合到肝脏移植团队中的可行性和试点A 单中心研究探索有针对性的社会支持是否改善了移植后的结果。这些目标 将提供必要的初步数据，用于未来的聚类，务实的多中心RCT测试 健康倡导者干预。 Wadhwani博士是大学的儿科助理教授 加利福尼亚，旧金山。在强大的研究支持基础的基础上，这项K23奖将建立 他是一项独立的卫生服务研究人员开创性研究，在小儿交集 肝病学，移植和健康的社会决定者。在直接监督 肝移植/多中心队列大楼（Jennifer Lai）的多学科领导者团队，儿科 肝病学和多中心临床试验设计（John Bucuvalas），社会护理整合到卫生系统中 （Laura Gottlieb）以及定性和实施科学方法（Courtney Lyles），Wadhwani博士将 执行一个详细的职业发展计划，以实现4个培训目标：（1）先驱A研究。 为接受肝移植的儿童整合社会和医疗服务，（2）在社会上发展专业知识 逆境测量和评估，（3）获取开发，测试和实施健康所需的技能 系统干预措施（例如，多中心前瞻性混合方法，调查方法，深入 访谈和民族志）以及（4）发展多中心研究设计的技能。