Reducing disparities in living donor transplant among African Americans

减少非裔美国人活体捐赠者移植方面的差异

• 批准号: 9919556
• 负责人: Kimberly Ruth Jacob Arriola
• 金额: $ 23.11万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9919556
• 关键词: Achievement; Acute; African American; Behavioral; Clinical; Communication; Complement; Cost Savings; Country; Coupled; Data; Dialysis procedure; Donor person; Dose; Education; Educational Background; Educational Intervention; Educational Materials; Educational Status; End stage renal failure; Environment; Evaluation; Family; Friends; Funding; Goals; Graft Survival; Grant; Health Care Costs; Health system; Individual; Intervention; Intervention Studies; Kidney; Kidney Transplantation; Knowledge; Light; Living Donors; Mediating; Modeling; Motivation; National Institute of Diabetes and Digestive and Kidney Diseases; Online Systems; Outcome; Pamphlets; Participant; Pathway interactions; Patients; Process; Provider; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Records; Research; Sampling; Self Efficacy; South Carolina; Southeastern United States; System; Testing; Time; Transplant Recipients; Transplantation; United States; United States Health Resources and Services Administration; Vision; Wait Time; Waiting Lists; behavior change; comparison intervention; disparity reduction; follow up assessment; follow-up; health disparity; hospitalization rates; insight; interest; intervention effect; living kidney donor; optimal treatments; primary outcome; programs; racial disparity; recruit; secondary analysis; secondary outcome; skills; statistics; stem; transplant centers; trial design; web site

Abstract For most of the patients in the United States with end stage renal disease (ESRD), kidney transplantation represents the optimal treatment. Moreover, living donor kidney transplantation (LDKT) offers numerous advantages over deceased donor kidney transplant such as better kidney quality, increased short- and long- term graft survival, lower rates of acute rejection, and reduced health care cost. Nevertheless, there are pervasive racial disparities in access to LDKT, with white ESRD patients four times more likely to receive a LDKT than African American ESRD patients. The long-term objective of this program of research is to understand the combined effect of a systems-level intervention that enhances communication between dialysis facility and transplant center clinicians (Transplant Referral EXchange or T-REX) and a culturally-sensitive individual-level educational intervention (web-based Living ACTS: About Choices in Transplantation and Sharing) on racial disparities in access to LDKT. The specific aims of the study are: (a) To develop and refine a web-based version of Living ACTS; (b) To conduct an outcome evaluation of the newly created web-based Living ACTS intervention by comparing the percent of patients with at least one inquiry from a potential living donor among patients who receive Living ACTS compared to those who receive a control website with an embedded educational video; and (c) To conduct a process evaluation of the newly created web-based Living ACTS intervention by adapting commonly used process evaluation constructs (context, reach, dose received, fidelity, and recruitment) for an online environment. We will conduct a randomized controlled trial among a sample of 800 African American ESRD patients in the southeastern United States (ESRD Network 6 in Georgia and South Carolina), the region of the country with the largest proportion of African American ESRD patients on the waiting list. Patients will be randomly assigned to one of two study conditions (intervention or control). Participants at all four collaborating transplant centers will be seen by providers who utilize T-REX, thus allowing us to test the independent effect of individual-level education on a systems-level intervention. The primary outcome is the percent of patients with at least one living donor inquiry. Secondary outcomes will test the effect of the intervention on key constructs of the Information-Motivation-Behavioral Skills model to determine possible mediating pathways. Participants will undergo baseline assessment, access either the intervention or control educational materials, and complete an immediate follow-up assessment. Living donor inquiries will be examined over the subsequent 12 months. The process evaluation will utilize transplant center administrative records, immediate follow-up data from participants, website usage statistics, and study records. It is anticipated that achievement of these aims will yield outcomes with great clinical and public health impact.

抽象的 对于美国大多数患有末期肾脏疾病（ESRD）的患者，肾脏移植 代表最佳治疗方法。此外，活着的供体肾脏移植（LDKT）提供了许多 优于死者肾脏肾移植的优势，例如肾脏质量更好，短期和长期增加 术语移植生存率，急性排斥率降低以及降低医疗保健成本。然而，有 访问LDKT的普遍种族差异，白色ESRD患者接受了四倍 LDKT比非裔美国人ESRD患者。该研究计划的长期目标是 了解系统级干预的综合效果，从而增强透析之间的沟通 设施和移植中心临床医生（移植推荐交换或T-Rex）和对文化敏感的 个人水平的教育干预（基于Web的生活行为：关于移植和 共享）关于访问LDKT的种族差异。该研究的具体目的是：（a）开发和完善 基于网络的生活行为； （b）对新创建的基于Web的结果进行结果评估 通过比较潜在生活中至少有一次查询的患者百分比来进行生活行为干预 与接受对照网站的患者相比，接受生活行为的患者的捐助者 嵌入式教育视频； （c）对新创建的基于网络的生活进行过程评估 通过调整常用的过程评估结构（上下文，覆盖范围，收到的剂量， 保真度和招聘）用于在线环境。 我们将在800名非裔美国人ESRD患者样本中进行随机对照试验 美国东南部（佐治亚州和南卡罗来纳州的ESRD Network 6），该国地区 等待名单上的非裔美国人ESRD患者中最大的比例。患者将是随机的 分配给两个研究条件之一（干预或对照）。所有四个合作移植的参与者 利用T-Rex的提供商将看到中心，从而使我们能够测试 有关系统级干预的个人级别教育。主要结果是患有 至少一个活着的捐助者查询。次要结果将测试干预对关键结构的影响 信息动机 - 行为技能模型，以确定可能的中介途径。参与者 将接受基线评估，访问干预或控制教育材料以及 立即完成后续评估。在随后的12个 月份。流程评估将利用移植中心的管理记录，立即随访数据 来自参与者，网站使用统计和研究记录。预计这些目标的成就 将产生临床和公共卫生影响巨大的结果。