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

基本信息

批准号：
8327822
负责人：
Amy Doggette Waterman
金额：
$ 53.12万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
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/8327822
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

项目摘要

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.

描述（由申请人提供）：与继续透析相比，肾移植可为终末期肾病 (ESRD) 患者延长 3 至 17 年的寿命，并提高生活质量。由于死者供体器官短缺，越来越多的肾病患者选择从家人和朋友那里接受肾脏，这一过程称为活体肾移植（LDKT）。尽管非裔美国人患 ESRD 的可能性是非裔美国人的 3.7 倍，但他们接受 LDKT 的可能性较小。因此，该项目将评估当 ESRD 患者使用 Explore Transplant 计算机化专家获得个性化指导和个性化反馈时，是否可以减少移植知识、接受 LDKT 的准备、移植医学评估的完成和 LDKT 接收方面的种族差异。系统。这项多层次研究还将研究其他已知的患者、家庭和医疗保健系统对 LDKT 的障碍如何影响专家系统的有效性。在密苏里州圣路易斯巴恩斯犹太移植中心接受移植医学评估的终末期肾病患者（465 名非裔美国人，465 名白人）将按种族进行分层，并随机分配到两种教育条件之一（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，处于专家系统状态的患者将收到单独定制的反馈报告和个性化指导，解决对行为改变重要的变量以及与 LDKT 健康差异相关的变量。对照患者将仅接受移植中心提供的标准护理教育。主要结果的变化将在四个时间点进行评估（院内评估日 (IHED)（基线）前 2 个月、IHED 后 2 个月和 6 个月以及基线后 18 个月）。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在 IHED 后 6 个月后 LDKT 准备情况和移植知识是否有所增加。目标 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：检验专家系统在改变 LDKT 决策和行为方面的有效性在非裔美国人和白人之间是否相同。目标 4：研究 LDKT 的已知患者、家庭和医疗保健系统障碍如何单独发挥作用以及与专家系统结合发挥作用，从而影响非裔美国人的决策和行为。研究结束时，我们将开发出一种创新且具有成本效益的探索移植专家系统，可供 5,000 个透析中心和 250 个移植中心的提供者使用，根据不同种族患者的个体需求定制 LDKT 讨论和教育。