Peer mentorship to improve outcomes in patients on maintenance hemodialysis

同伴指导可改善维持性血液透析患者的治疗效果

• 批准号: 10005348
• 负责人: Kerri Cavanaugh
• 金额: $ 52.68万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-06 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10005348
• 关键词: Accident and Emergency department; Address; Adherence; Albumins; Behavior; Cardiovascular Diseases; Caring; Chronic Disease; Clinical Trials; Complex; Control Groups; Dialysis patients; Dialysis procedure; Diet; Education; Educational Curriculum; Educational process of instructing; Emergency department visit; End stage renal failure; Evaluation; Failure; Geographic Locations; Geography; Goals; Health behavior; Healthcare Systems; Hemodialysis; Hospitalization; Hospitals; Hour; Intervention; Knowledge; Liquid substance; Location; Maintenance; Medical; Medicare; Mentors; Mentorship; Modeling; Morbidity - disease rate; Motivation; New York; Nutritional; Outcome; Outcome Study; Participant; Patient Care; Patient Education; Patients; Physicians; Population; Positioning Attribute; Provider; Randomized; Records; Research; Resources; Schedule; Self Efficacy; Self Management; Social Perception; Social support; Structure; Telephone; Testing; Training; Training Programs; Urea; Visit; Weight; Weight Gain; base; behavioral adherence; behavioral outcome; cardiovascular infection; cost; design; high risk; hospital utilization; hospitalization rates; improved; improved outcome; innovation; mortality; patient population; patient-level barriers; peer; peer coaching; pragmatic trial; primary outcome; programs; recruit; satisfaction; secondary outcome; self-management program; skills; therapy design; tool; treatment as usual; trial comparing; usual care arm

PROJECT SUMMARY / ABSTRACT The proposed project tests an intervention to improve outcomes in patients with end- stage renal disease (ESRD). Patients treated with hemodialysis are at disproportionally high risk for hospitalizations which are both costly to the health care system and are associated with high morbidity and mortality. A portion of hospitalizations in patients on hemodialysis are avoidable and may reflect a failure of self-management of dialysis parameters and adherence. Patient education that is provided by dialysis facilities focuses on dialysis quality metrics set by Medicare for reimbursement purposes. They seldom inform patients about concrete skills, nor do they increase self-efficacy with regards to behavioral outcomes. Patient level barriers to dialysis self-management include low knowledge about the relation of fluid metrics, dialysis adherence and dietary plans to short and long-term outcomes. We aim to employ the Information, Motivation and Behavior (IMB) Skills Model of improving adherence in medical care. We will use a peer mentorship model to provide information and motivation in order to improve adherence behaviors in patients with ESRD. Peer mentorship has been shown to increase theoretical and practical knowledge in patients with chronic disease, and peer-mentors increase perception of social support and self-efficacy in their mentees. We propose a pragmatic trial evaluating the effects of a peer-mentor program focused on increasing dialysis self-management in high risk patients on hemodialysis. Our primary outcome is the composite of emergency department visits and hospitalizations. Our study will be conducted in 2 geographic locations (Bronx, NY and Nashville, TN) to evaluate scalability and acceptability in different patient populations. We will recruit 20 peer mentors and train them using a curriculum based on the IMB model of improving adherence. Two hundred patients with ESRD will be recruited from 7 dialysis centers and will be randomized to either the peer mentorship intervention or a usual care control group. Trained mentors will implement a telephone intervention for 3 months and participants will be followed for an additional 15 months to evaluate study outcomes. This proposal is innovative and addresses challenges related to patient level barriers to self-management, high hospitalization rates and disproportionate morbidity and mortality with a low cost, scalable and pragmatic intervention.

项目摘要 /摘要 拟议的项目测试了一种干预措施，以改善终点患者的预后 阶段肾脏疾病（ESRD）。血液透析治疗的患者不成比例 住院的风险对医疗保健系统都是昂贵的，并且与 高发病和死亡率。血液透析患者的一部分住院是 可以避免，并且可能反映了透析参数和依从性的自我管理的失败。 透析设施提供的患者教育重点是透析质量指标 用于报销目的的Medicare。他们很少向患者告知具体技能，也不 它们在行为结果方面是否增加了自我效能感。患者级别的障碍 透析自我管理包括有关流体指标关系的知识较低，透析 遵守和饮食计划，以短期和长期结局。我们的目标是利用 改善医学依从性的信息，动机和行为（IMB）技能模型 关心。我们将使用同行指导模型来提供信息和动力，以便 改善ESRD患者的依从性行为。同行指导已被证明 增加慢性病患者和同伴患者的理论和实践知识 增加对受训者中社会支持和自我效能感的看法。我们提出了一个 务实的试验评估了同伴计划的效果，该计划着重于增加透析 血液透析中高风险患者的自我管理。我们的主要结果是综合 急诊室就诊和住院。我们的研究将在2中进行 地理位置（纽约州​​布朗克斯，田纳西州纳什维尔），以评估可伸缩性和可接受性 不同的患者人群。我们将招募20位同行导师，并使用课程培训他们 基于IMB改善依从性的模型。 ESRD患者将是 从7个透析中心招募，并将随机分为同伴指导 干预或通常的护理控制组。训练有素的导师将实施电话 干预3个月，参与者将额外遵循15个月的时间 评估研究结果。该建议是创新的，并解决了与 自我管理，高住院率和不成比例的患者水平障碍 发病率和死亡率低成本，可扩展和务实的干预。