House Calls and Decision Support: Increasing Access to Live Donor Transplantation

出诊和决策支持：增加活体捐赠者移植的机会

基本信息

批准号：
8550042
负责人：
James R Rodrigue
金额：
$ 25.09万
依托单位：
BETH ISRAEL DEACONESS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-24 至 2017-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8550042
关键词：
Activities of Daily Living Acute Adult Affect Age Attenuated Awareness Cessation of life Chronic Chronic Kidney Failure Clinic Clinical Control Groups Decision Making Dialysis procedure Disadvantaged Discrimination Education Educational Materials Effectiveness End stage renal failure Enrollment Ethnic Origin Evaluation Exposure to Facilities and Administrative Costs Failure Feedback Gender Health Care Costs Health Educators Healthcare Hispanics Home environment House Call Household Income Intervention Kidney Kidney Transplantation Knowledge Life Living Donors Low Income Population Low income Mediating Mediator of activation protein Minority Minority Groups Modeling Morbidity - disease rate Nature Online Systems Organ Transplantation Outcome Participant Patients Quality of life Race Randomized Randomized Controlled Trials Readiness Relative (related person)Research Sampling Self Efficacy Site Social Network Staging Study Section Survival Rate Time Transplantation United States Woman base burden of illness effective intervention experience functional status health disparity improved innovation male member men mortality multidisciplinary novel patient oriented patient population peer primary outcome programs public health relevance secondary outcome socioeconomics success therapy design willingness

项目摘要

DESCRIPTION (provided by applicant): While kidney transplantation is the best treatment option for adults with end-stage renal disease (ESRD), profound racial and socioeconomic disparities persist. Minorities and low-income patients, for instance, are less likely to receive lve donor kidney transplantation (LDKT), which yields better survival, quality of life, and health care cost outcomes than chronic dialysis or deceased donor transplantation. Guided by a socio- ecological model of LDKT, the PI developed an innovative House Calls intervention that has shown to be effective at overcoming barriers and increasing LDKT rates in Black patients. We now seek to expand the reach and intensity of the House Calls intervention by including other minorities and socioeconomically disadvantaged patients and by adding a novel Patient-Centered Decision Support component. Also, little is known about those variables that mediate the intervention's impact on the occurrence of LDKT or whether the intervention can attenuate the growing gender disparity in living donation. In this study, we will pursue three specific aims: (1) evaluate the differential benefit of adding a patient-centered decision support component to the House Calls intervention; (2) identify mediators of the relationship between the interventions and the occurrence of LDKT; and (3) examine whether the House Calls intervention reduces the gender disparity in rates of living kidney donation. To accomplish these aims, we will conduct a single-site, randomized controlled trial with a planned enrollment of 100 minority and low income patients awaiting kidney transplantation. Patients will be randomized to receive the House Calls intervention alone (HC) or the House Calls intervention + a web-based Patient-Centered Decision Support intervention (HC+DS). The central hypothesis is that, compared to HC alone, the HC+DS group will have a higher proportion of enrolled patients with LDKT by the 2-yr study endpoint (primary outcome) and higher proportions of enrolled patients with at least one live donor inquiry, at least one live donor evaluation, and in LDKT action (vs. contemplation) stages (secondary outcomes). Also, we will evaluate whether the House Calls intervention (either HC alone or HC+DS) leads to more donor inquiries, evaluations, and actual donations from men, relative to a non-intervention control group, controlling for patient race/ethnicity, gender, age, and household income. By identifying effective interventions for patient populations with historically lower rates of LDKT, we can eliminate many barriers to access, reduce disease burden, and lower mortality rates by producing more donor organs for transplantation. We are especially well-prepared to conduct the proposed research due to the multidisciplinary nature of the research team, as well as the expertise and experience of the team in developing LDKT and living donation educational materials, implementing and evaluating the House Calls intervention, conducting LDKT research with minorities and socioeconomically disadvantaged patients, and producing meaningful scientific and clinical outcomes.

描述（由申请人提供）：虽然肾脏移植是终末期肾脏疾病（ESRD）的最佳治疗选择，但持续存在种族和社会经济差异。例如，少数族裔和低收入患者接受LVE供体肾脏移植（LDKT）的可能性较小，它可以产生更好的生存，生活质量和医疗保健成本结果比慢性透析或已故供体移植。在LDKT的社会生态模型的指导下，PI开发了一种创新的房屋呼叫干预措施，该干预措施已证明在克服黑人患者的障碍和LDKT率提高方面有效。现在，我们试图通过包括其他少数民族和弱势群体的患者，并添加一种新颖的以患者为中心的决策支持部分来扩大房屋呼叫干预的影响力和强度。同样，对于那些介导干预措施对LDKT发生的影响的变量，或干预措施是否可以减轻生活捐赠中日益增长的性别差异。在这项研究中，我们将追求三个具体目标：（1）评估在众议院呼叫干预中添加以患者为中心的决策支持部分的差异益处；（2）确定干预措施与LDKT发生之间关系的介体；（3）检查房屋的干预是否会降低活肾脏捐赠率的性别差异。为了实现这些目标，我们将进行一项单一站点，随机对照试验，并计划在等待肾脏移植的100名少数族裔和低收入患者中入学。患者将被随机接收单独接收家庭电话干预（HC）或众议院呼叫干预 +基于网络的以患者为中心的决策支持干预措施（HC + DS）。中心假设是，与仅HC相比，HC+DS组将通过2年研究终点（主要结果）和更高比例的有LDKT的LDKT患者的比例更高，并且至少有一个现场捐助者询问，至少一个现场捐助者评估，至少是LDKT行动（vs. vs. persplation）阶段（vs. persplation）阶段（第二阶段）（第二阶段）（第二阶段）。另外，我们将评估众议院呼吁干预（单独使用HC或HC+DS）是否会导致更多的捐助者查询，评估和实际捐款，从而相对于非干预对照组，从而控制了患者种族/民族，性别，年龄和家庭收入。通过确定LDKT率较低的患者人群的有效干预措施，我们可以通过产生更多的供体器官进行移植来消除许多进入，减轻疾病负担和降低死亡率的障碍。由于研究团队的多学科性质，以及该团队在开发LDKT和生活捐赠教育材料，实施和评估房屋呼吁干预，与少数群体和社会经济上的少数群体和社会上有意义的科学和有意义的科学企业的科学和持有意义的科学家，我们的专业知识和经验以及团队在开发LDKT和生活捐赠教育材料方面的专业知识和经验以及团队的专业知识和经验，以及在开发LDKT和生活的教育材料方面的专业知识和经验，以及在开发LDKT和评估的科学方面，我们的专业知识和评估。