TAILORED COMPUTER EDUCATION TO INCREASE LIVING DONATION IN AFRICAN-AMERICANS

定制计算机教育以增加非裔美国人的活体捐赠

• 批准号: 8144607
• 负责人: Amy Doggette Waterman
• 金额: $ 65.55万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8144607
• 关键词: Address; Affect; African American; Applications Grants; Award; Behavior; Behavioral Model; Caring; Computerized Medical Record; Computers; Control Groups; Decision Making; Dialysis procedure; Education; Effectiveness; End stage renal failure; Evaluation; Expert Systems; Family; Feedback; Friends; Grant; Health; Health Care Costs; Health Insurance; Health Personnel; Health Services Accessibility; Health behavior; Healthcare; Healthcare Systems; Hospitals; Individual; Intervention Studies; Kidney; Kidney Failure; Kidney Transplantation; Knowledge; Life; Living Donors; Longevity; Mails; Medical; Missouri; Oral; Organ Donor; Outcome; Patients; Physicians; Printing; Process; Provider; Quality of life; Race; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Reporting; Request for Applications; Surveys; System; Telephone; Testing; Time; Transplantation; base; behavior change; caucasian American; computer generated; computerized; cost effective; effective intervention; follower of religion Jewish; health disparity; improved; innovation; interest; Address; Affect; African American; Applications Grants; Award; Behavior; Behavioral Model; Caring; Computerized Medical Record; Computers; Control Groups; Decision Making; Dialysis procedure; Education; Effectiveness; End stage renal failure; Evaluation; Expert Systems; Family; Feedback; Friends; Grant; Health; Health Care Costs; Health Insurance; Health Personnel; Health Services Accessibility; Health behavior; Healthcare; Healthcare Systems; Hospitals; Individual; Intervention Studies; Kidney; Kidney Failure; Kidney Transplantation; Knowledge; Life; Living Donors; Longevity; Mails; Medical; Missouri; Oral; Organ Donor; Outcome; Patients; Physicians; Printing; Process; Provider; Quality of life; Race; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Reporting; Request for Applications; Surveys; System; Telephone; Testing; Time; Transplantation; base; behavior change; caucasian American; computer generated; computerized; cost effective; effective intervention; follower of religion Jewish; health disparity; improved; innovation; interest

DESCRIPTION (provided by applicant): Kidney transplantation offers patients in end-stage renal disease (ESRD) 3 to 17 additional years of life and improved quality-of-life compared to remaining on dialysis. Because of the deceased donor organ shortage, more kidney patients are choosing to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although African-Americans are 3.7 times more likely to develop ESRD, they are less likely to receive LDKTs. Therefore, this project will assess whether racial disparities in transplant knowledge, readiness to pursue LDKT, completion of transplant medical evaluation, and receipt of LDKTs can be reduced when ESRD patients receive access to personalized coaching and individually-tailored feedback using an Explore Transplant computerized Expert System. This multilevel study will also examine how other known patient, family, and healthcare system barriers to LDKT impact the Expert System's effectiveness. ESRD patients presenting for transplant medical evaluation at Barnes-Jewish Transplant Center in St. Louis, Missouri (465 African-Americans, 465 Whites) will be stratified by race and randomized to one of two education conditions (Explore Transplant Expert System vs. Standard Education Control). As they complete transplant medical evaluation, patients in the Expert System condition will receive individually tailored feedback reports and personalized coaching addressing variables important to behavior change and associated with LDKT health disparities. Control patients will only receive standard-of-care education provided by the transplant center. Changes in key outcomes will be assessed at four time points (2-months before in-hospital evaluation day (IHED) (baseline), 2- and 6-months post-IHED, and 18-months post-baseline). The grant has four aims: Aim 1 (Primary): Compared to the Control Group, to determine whether African-American and White patients receiving the Expert System increase in their LDKT readiness and transplant knowledge 6-months post-IHED. Aim 2: Compared to the Control group, to determine whether African-American and White patients receiving the Expert System are more likely to complete transplant medical evaluation and pursue LDKT 18- months post-baseline. Aim 3: To examine whether the Expert System's effectiveness in changing LDKT decision-making and behavior is equivalent between African-Americans and Whites. Aim 4: To examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with the Expert System to affect African-Americans' decision-making and behavior. At the conclusion of the study, we will have developed an innovative and cost-effective Explore Transplant Expert System that could be utilized by providers in 5,000 dialysis and 250 transplant centers to tailor LDKT discussion and education based on the needs of individual patients of different races. PUBLIC HEALTH RELEVANCE: Patients with kidney failure have better health and quality-of-life when they receive a transplant, especially a transplant from a living donor (LDKT). Although kidney failure disproportionately affects African-Americans, Whites are more likely to receive LDKTs. This randomized controlled trial of 930 African-American and White patients will develop and assess the effectiveness of individually tailored, computer-generated education using an Expert System for overcoming specific barriers affecting African-Americans' pursuit of LDKT.

描述（由申请人提供）：与保持透析相比，肾脏移植为患者提供了末期肾脏疾病（ESRD）的患者3至17年的寿命和寿命改善。由于已故的供体器官短缺，越来越多的肾脏患者选择从家人和朋友那里接收肾脏，这一过程称为活供体肾脏移植（LDKT）。尽管非裔美国人发展ESRD的可能性高3.7倍，但他们接受LDKT的可能性较小。因此，该项目将评估移植知识的种族差异，寻求LDKT的准备，完成移植医学评估以及当ESRD患者获得个性化教练的访问权限以及使用探索式计算机化的计算机专家系统获得个性化的反馈时，可以减少LDKT的收到。这项多级研究还将研究其他已知的患者，家庭和医疗保健系统的LDKT障碍如何影响专家系统的有效性。在密苏里州圣路易斯的Barnes-Jewish移植中心进行移植医学评估的ESRD患者（465名非裔美国人，465名白人）将按种族进行分层，并随机分为两种教育条件之一（探索移植专家系统与标准教育控制）。当他们完成移植医学评估时，专家系统状况的患者将获得单独量身定制的反馈报告和个性化的教练，以解决对行为改变重要的变量，并与LDKT健康差异相关。控制患者将仅接受移植中心提供的护理标准教育。关键结果的变化将在四个时间点（院内评估日（IHED）（基线）（基线），2个月后2个月和6个月后以及基线后的18个月）进行评估。该赠款有四个目标：目标1（主要）：与对照组相比，确定接受专家系统的非裔美国人和白人患者的LDKT准备就绪和移植知识是否增加了6个月后IHED。 AIM 2：与对照组相比，确定接受专家系统的非裔美国人和白人患者是否更有可能完成移植医学评估并在基线后18个月进行LDKT。 目标3：检查专家系统在改变LDKT决策和行为方面的有效性是否等效于非裔美国人和白人。 目的4：检查已知的患者，家庭和医疗保健系统对LDKT行为的障碍是如何与专家系统结合在一起的，以影响非裔美国人的决策和行为。 在研究结束时，我们将开发一种创新且具有成本效益的探索移植专家系统，该系统可以被5,000名透析和250个移植中心的提供商使用，以根据不同种族的个别患者的需求来量身定制LDKT讨论和教育。 公共卫生相关性：肾衰竭患者接受移植时的健康和生活质量更好，尤其是来自活捐赠者（LDKT）的移植。尽管肾脏衰竭对非裔美国人的影响不成比例，但白人更有可能接受LDKT。这项对930名非裔美国人和白人患者的随机对照试验将使用专家系统来克服影响非裔美国人追求LDKT的特定障碍，从而开发和评估单独定制的计算机基础教育的有效性。