Multilevel Intervention Strategies to Transform Kidney Care and Improve Pursuit of Transplant in an Integrated Healthcare Delivery System

在综合医疗服务系统中转变肾脏护理并改善移植的多层次干预策略

• 批准号: 10683218
• 负责人: BRIAN S MITTMAN
• 金额: $ 40万
• 依托单位: METHODIST HOSPITAL RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10683218
• 关键词: Multilevel; Intervention; Strategies; Transform; Kidney

PROJECT SUMMARY Approximately 15% of the U.S. population has chronic kidney disease, and ~700,000 patients are in full kidney failure also called end-stage kidney disease (ESKD). The optimal treatment for ESKD is living donor kidney transplantation (LDKT), followed by deceased donor kidney transplantation (DDKT); however, the standard of care continues to be ongoing dialysis, which has poor clinical outcomes in comparison to LDKT and DDKT. Best practices to transform kidney care recommended by the Centers for Medicare and Medicaid Services (CMS), the American Society of Nephrology (ASN) and the 2019 Executive Order Advancing American Kidney Health Initiative include earlier detection of patients whose kidneys are deteriorating rapidly, introducing transplant as a potential treatment option earlier, optimally before their kidneys fail, improved dissemination of health literate transplant education tools, often through digital technology or mHealth, and increasing LDKT rates by helping patients locate living donors or motivating others to donate. Barriers at the patient-, support network-, clinician- and system-levels of the Socio-Ecological Model persist, including poor identification of high-risk patients, insufficient clinician time to discuss transplant, poor transplant knowledge, reluctance or insufficient support to ask living donors to donate, and disengaged friends and relatives, some of whom who might become living donors. While extensive policy and intervention efforts are underway, none have achieved significant increases in pursuit and receipt of transplant, especially LDKT rates. In 2017, Kaiser Permanente Southern California (KPSC), an integrated care system serving 24,000 CKD patients, partnered with the Transplant Research and Education Center (TREC) at Houston Methodist Research Institute (HMRI) and J.C. Walter Jr. Transplant Center Houston Methodist Hospital (HMH) to launch a multi-year plan for transforming CKD and ESKD care. We now propose to conduct a pragmatic stepped wedge cluster randomized trial of a novel multilevel intervention to improve CKD and ESKD care, improve transplant rates and reduce disparities. One innovative component of the multilevel intervention is a state-of-the-art technology-supported Grove Kidney Health mHealth application, developed in partnership with patients, to engage patients, family members, and potential living donors to improve their CKD knowledge, view transplant success stories, and seek kidney-related support to pursue transplant, including learning how to find living donors. We also seek to identify moderators at various socio- ecological levels, especially factors influencing variations in effectiveness across different settings and among underserved patient subgroups known to have reduced access to transplant and build implementation tools to increase access to and pursuit of transplant within large integrated health systems including comparable systems (commercial, academic, safety net) across the U.S.

项目概要 大约 15% 的美国人患有慢性肾病，约 700,000 名患者患有全肾病 衰竭也称为终末期肾病（ESKD）。 ESKD 的最佳治疗方法是活体供肾 移植（LDKT），然后进行死者供体肾移植（DDKT）；然而，标准 护理仍然是持续透析，与 LDKT 和 DDKT 相比，其临床结果较差。最好的 医疗保险和医疗补助服务中心 (CMS) 建议的改变肾脏护理的实践， 美国肾脏病学会 (ASN) 和 2019 年促进美国肾脏健康的行政命令 倡议包括及早发现肾脏迅速恶化的患者，将移植作为一种治疗方法 尽早提供潜在的治疗选择，最好是在肾脏衰竭之前，改善健康素养的传播 移植教育工具，通常通过数字技术或移动医疗，并通过帮助提高 LDKT 率 患者找到活体捐赠者或激励其他人捐赠。患者、支持网络、临床医生的障碍 社会生态模型的系统层面仍然存在，包括对高风险患者的识别不力， 临床医生没有足够的时间讨论移植、移植知识匮乏、不愿意或支持不足 要求活体捐赠者捐赠，并要求脱离的朋友和亲戚，其中一些人可能会成为活人 捐助者。虽然广泛的政策和干预措施正在进行中，但没有取得显着的增长 追求和接受移植，尤其是 LDKT 率。 2017 年，南加州凯撒医疗机构 (KPSC) 是一个为 24,000 名 CKD 患者提供服务的综合护理系统，与移植研究和 休斯顿卫理公会研究所 (HMRI) 教育中心 (TREC) 和 J.C. Walter Jr. 移植中心 休斯顿卫理公会医院 (HMH) 将启动一项多年计划来转变 CKD 和 ESKD 护理。我们现在 提议对一种新颖的多层次干预措施进行务实的阶梯式楔形集群随机试验，以 改善 CKD 和 ESKD 护理，提高移植率并缩小差距。的一项创新组成部分 多层次干预是一种由最先进技术支持的 Grove Kidney Health mHealth 应用程序， 与患者合作开发，让患者、家庭成员和潜在的活体捐赠者参与 提高他们的 CKD 知识，查看移植成功案例，并寻求肾脏相关支持以追求 移植，包括学习如何寻找活体捐赠者。我们还寻求确定各个社会领域的主持人 生态水平，特别是影响不同环境和不同环境下有效性差异的因素 已知服务不足的患者亚群获得移植的机会减少，并建立实施工具 在大型综合卫生系统（包括类似系统）内增加移植的机会和追求 （商业、学术、安全网）遍布全美