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。 小儿肝移植对于患有终末期肝病的儿童来说是一种挽救生命的手术，但长期 面临社会逆境的儿童和社会经济贫困的儿童的结果仍然不理想。 背景增加了移植后移植失败和死亡的风险。 结果是众所周知的，但迄今为止该领域还无法克服这些问题。 初级保健正在迅速发展，以开发对特定社会风险因素的评估并整合有效的 采取干预措施解决物质经济困难（例如粮食不安全）、健康素养差、护理人员 心理健康、社会隔离和邻里环境是一种可用于其他领域的潜在策略。 将健康倡导者（帮助患者/家庭应对社会风险的团队成员）纳入 临床团队根据接受移植肝移植的儿童的需求调整健康倡导者干预措施， 更细致地了解哪些儿童面临最高风险，以及健康倡导者如何整合 为此，需要移植团队内部的支持，这项研究将利用 Wadhwani 博士正在进行的 KL2。 横跨 8 个美国移植中心的资助多中心前瞻性队列 (SOCIAL-Tx)，以实现以下目标 目的：(1) 描述移植时的社会风险与移植后不良后果之间的关联。 移植后 1 年和 3 年；(2) 采用多利益相关者定性访谈（患者/家属、医生、 护士、社会工作者）来描述为患者/家庭提供最佳移植护理的障碍和促进因素 （3）评估将健康倡导者纳入肝移植团队的可行性并进行试点 单中心研究探讨有针对性的社会支持是否可以改善移植后的结果。 将为未来的集群式、务实的多中心随机对照试验（RCT）测试提供必要的初步数据 健康倡导者干预博士瓦德瓦尼 (Wadhwani) 是阿布扎比大学儿科助理教授。 K23 奖项将建立在强大的研究支持基础上。 作为一名独立的健康服务研究员，他在儿科交叉领域开展了开创性的研究 肝病学、移植和健康的社会决定因素。 肝移植/多中心队列建设多学科领导团队（Jennifer Lai）、儿科 肝病学和多中心临床试验设计（John Bucuvalas）、社会护理融入卫生系统 （Laura Gottlieb），以及定性和科学实施方法（Courtney Lyles），Wadhwani 博士将 执行详细的职业发展计划，以实现 4 个培训目标：(1) 开拓研究领域 将接受肝移植的儿童的社会护理和医疗护理结合起来，(2) 发展社会专业知识 逆境测量和评估，(3) 获得开发、测试和实施健康所需的技能 系统干预（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) 培养多中心研究设计技能。