CKD awareness and self-management: Interventions for Safety-Net Patients

CKD 意识和自我管理：安全网患者的干预措施

基本信息

批准号：
8442811
负责人：
Delphine Tuot
金额：
$ 18.84万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
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：
2012-09-20 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8442811
关键词：
Adoption Adult Affect Anti-Inflammatory Agents Anti-inflammatory Applications Grants Arthritis Awareness Behavior Behavioral Biometry Biostatistical Methods California Car Phone Caring Cessation of life Chronic Disease Chronic Kidney Failure Clinical Clinical Research Communities Counseling Data Data Collection Development Diabetes Mellitus Disease Disease Management Disease Outcome Disease Progression Education Effectiveness End stage renal failure Excess Mortality Funding Future General Hospitals Goals Head Health Health behavior change Health behavior outcomes Hospitalization Hypertension Individual Intervention Interview K-Series Research Career Programs Kidney Kidney Diseases Life Life Style Link Measures Mediating Medical Medicine Mentored Patient-Oriented Research Career Development Award Mentors Methods Morbidity - disease rate Multi-Institutional Clinical Trial National Institute of Diabetes and Digestive and Kidney Diseases Nephrology Obesity Outcome Outcomes Research Participant Patients Pharmaceutical Preparations Physical activity Pilot Projects Population Prevalence Qualitative Research Random Allocation Randomized Controlled Trials Registries Research Research Methodology Research Personnel Risk Risk Reduction Behavior Role Safety San Francisco Self Efficacy Self Management Structure System Technology Telephone Testing Text Time Tobacco Tobacco use Training Translations United States United States National Institutes of Health Universities Ursidae Family Vulnerable Populations base behavior change behavior measurement blood pressure regulation burden of illness career career development cohort design ethnic minority population evidence base experience follow-up implementation research improved innovation kidney disease education low socioeconomic status novel patient oriented preference professor programs prospective safety net treatment as usual

项目摘要

DESCRIPTION (provided by applicant): This is a re-submission for a K23 award for Dr. Delphine Tuot, a nephrologist at the University of California, San Francisco. Dr. Tuot is establishing herself as a young investigator in patient-oriented clinical research of chronic kidney disease (CKD). This K23 award will provide Dr. Tuot with the support necessary to accomplish the following goals: (1) to become an expert in the implementation of interventions that improve health outcomes for patients with CKD, in particular those who receive care in a safety-net setting; (2) to implement advanced biostatistical methods in clinical studies; (3) to develop expertise in qualitative research methods and (4) develop an independent clinical research career. To achieve these goals, Dr. Tuot has assembled a mentoring team led by two primary mentors, Dr. Neil Powe, Distinguished Professor, Vice-Chair of Medicine at UCSF and Chief of Medicine at San Francisco General Hospital, whose research program focuses on improving CKD disparities; and Dr. Chi-yuan Hsu, Professor, Chief of Nephrology at UCSF and expert in CKD outcomes research. Her larger mentoring team also includes Dr. Margaret Handley, a nationally recognized leader in the field of implementation research in vulnerable populations and Dr. Charles McCulloch, Head of the Division of Biostatistics at UCSF and expert in longitudinal analyses for repeated measures. Dr. Daniel Dohan, who has expertise in qualitative research methods with a focus on chronic disease, will serve as a very close collaborator. CKD is common in the U.S. adult population and is associated with excess mortality and morbidity. There has been poor adoption of evidence-based therapies (medical and behavioral) that improve health outcomes among CKD patients. The lack of translation may be in part due to low patient awareness of CKD, which may disproportionately affect safety-net populations. Dr. Tuot's research will examine the impact of CKD awareness on patient behaviors and health outcomes (Aim 1) and investigate whether an evidence-based CKD-specific self-management program using novel telephone technology, impacts CKD progression through increased patient self-efficacy regarding CKD and greater engagement in risk-reduction behaviors (Aim 2). Additionally, she will identify safety-net patients' perceived role in disease management and their unmet needs to engage in behaviors that slow CKD progression. Results of both her quantitative and qualitative studies will refine the telephone intervention in Aim 2 an inform the development and administration of a new text-based self-management support program for safety-net patients with CKD who may not engage with telephone interventions (Aim 3). This research will form the basis for a multi-center clinical trial assessing the efficacy and effectiveness of various self-management programs on health outcomes among diverse patients with CKD, to be proposed in an R01 grant application before the end of the K award period. PUBLIC HEALTH RELEVANCE: Chronic kidney disease affects up to 13% of the United States adult population and leads to excess mortality and morbidity. Delivery of effective management for CKD is limited because few CKD patients are aware of their disease, which is largely clinically silent. In this study, we plan to explore the implications of patient awareness of CKD o health outcomes, examine the impact of an existing CKD self-management program on behavior change and identify safety-net patients' unmet needs to engage in risk-reduction behaviors. In turn, these data will be used to refine an existing telephone self-management program and inform the development and administration of a text-based CKD self-management support intervention, both designed to improve health outcomes among safety-net patients with CKD.

描述（由申请人提供）：这是为加州大学旧金山分校肾病专家 Delphine Tuot 博士重新提交的 K23 奖项。 Tuot 博士正在将自己定位为以患者为导向的慢性肾脏病 (CKD) 临床研究领域的年轻研究者。该 K23 奖项将为 Tuot 博士提供实现以下目标所需的支持：(1) 成为实施干预措施的专家，改善 CKD 患者的健康结果，特别是那些在安全网中接受护理的患者环境; （2）在临床研究中实施先进的生物统计学方法； (3) 发展定性研究方法方面的专业知识；(4) 发展独立的临床研究职业。为了实现这些目标，Tuot 博士组建了一个由两位主要导师 Neil Powe 博士领导的指导团队，Neil Powe 博士是加州大学旧金山分校的杰出教授、医学副主任和旧金山总医院的医学主任，其研究项目侧重于改善CKD 差异；以及 UCSF 肾病科主任教授、CKD 结果研究专家徐志远博士。她的更大的指导团队还包括玛格丽特·汉德利博士（Margaret Handley）和查尔斯·麦卡洛克（Charles McCulloch）博士。玛格丽特·汉德利博士是全国公认的弱势群体实施研究领域的领导者，查尔斯·麦卡洛克博士是加州大学旧金山分校生物统计学系主任、重复测量纵向分析专家。 Daniel Dohan 博士在专注于慢性病的定性研究方法方面拥有专业知识，他将作为一位非常密切的合作者。 CKD 在美国成年人中很常见，并且与过高的死亡率和发病率相关。改善 CKD 患者健康状况的循证疗法（医学和行为）的采用率很低。缺乏翻译可能部分是由于患者对 CKD 的认识较低，这可能会对安全网人群产生不成比例的影响。 Tuot 博士的研究将考察 CKD 意识对患者行为和健康结果的影响（目标 1），并调查使用新型电话技术的循证 CKD 特异性自我管理计划是否通过提高患者自我效能来影响 CKD 进展： CKD 和更多地参与降低风险的行为（目标 2）。此外，她还将确定安全网患者在疾病管理中的感知角色，以及他们在参与减缓 CKD 进展的行为方面未得到满足的需求。她的定量和定性研究结果将完善目标 2 中的电话干预，并为可能不参与电话干预的 CKD 安全网患者开发和管理新的基于文本的自我管理支持计划提供信息（目标 3 ）。这项研究将为评估疗效的多中心临床试验奠定基础以及各种自我管理计划对不同 CKD 患者健康结果的有效性，将在 K 奖励期结束之前在 R01 拨款申请中提出。公共卫生相关性：慢性肾病影响着高达 13% 的美国成年人口，并导致死亡率和发病率过高。对 CKD 的有效治疗是有限的，因为很少有 CKD 患者意识到自己的疾病，而这种疾病在临床上基本上是沉默的。在这项研究中，我们计划探讨患者对 CKD 的认识对健康结果的影响，检查现有 CKD 自我管理计划对行为改变的影响，并确定安全网患者参与降低风险行为的未满足需求。反过来，这些数据将用于完善现有的电话自我管理计划，并为基于文本的 CKD 自我管理支持干预措施的开发和管理提供信息，两者都旨在改善安全网 CKD 患者的健康结果。