Mitigating the Effects of Structural Racism on Chronic Kidney Disease Disparities among African Americans

减轻结构性种族主义对非裔美国人慢性肾病差异的影响

基本信息

批准号：
10742680
负责人：
Kimberly Ruth Jacob Arriola
金额：
$ 79.1万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10742680
关键词：
Address African American African American population Allografting Attention Automobile Driving Black race Caring Chronic Disease Chronic Kidney Failure Client satisfaction Clinical Collaborations Communities Country Development Dialysis procedure Disease Outcome Disease Progression Disparity Donor person Effectiveness of Interventions Elements Employment Environment Equity Evaluation Failure Generations Goals Health Health Services Accessibility Health Status Health system Healthcare Healthcare Systems Home Hemodialysis Improve Access Income Inequity Interruption Intervention Kidney Knowledge Link Mission Modeling National Institute of Diabetes and Digestive and Kidney Diseases Nephrology Organ Preservation Outcome Pathway interactions Patient-Focused Outcomes Patients Physicians Population Primary Care Productivity Provider Public Health Public Health Applications Research Quality of life Quasi-experiment Race Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Role Science Series Site Structural Racism Structure System Time Transplantation Treatment outcome Work acute care anti-racism black patient care outcomes chronic care model community engagement design disease disparity effectiveness evaluation health care delivery health care settings health equity health organization implementation evaluation implementation outcomes improved innovation interest lens multi-component intervention primary outcome racial disparity racism response social determinants social health determinants uptake

项目摘要

ABSTRACT Racial disparities in advanced chronic kidney disease (CKD) treatment, care, and patient outcomes are profound, persistent, and pervasive. Despite a large volume of studies linking structural racism to a range of health outcomes, only recently has there been a surge in attention to the role of racism in driving the well- documented inequities in CKD. Effective CKD treatment and care can improve quality of life, reduce the need for deceased donor transplant, decrease the likelihood of allograft failure, and improve long-term patient survival; yet racial disparities exist at each point along this pathway of care due to structural racism. The Collaborative Chronic Care Model (CCM) offers a well-established, multi-level framework for organizing health systems in order to maximize outcomes among patients with chronic diseases such as CKD; however, alone, it fails to attend to the role of structural racism. We propose multi-level, multi-component interventions under a new innovative framework to motivate systemic change: we will apply the four foci of Public Health Critical Race Praxis (PHCRP), a public health framework that addresses change through an anti-racism lens, to the six components of the CCM to impact CKD care in primary care and acute care access points, nephrology, and dialysis care settings. In this manner, we propose to redesign structures within Emory Healthcare to mitigate the effect of structural racism on CKD inequities. Our long-term goal is to eliminate racial inequities in CKD progression, treatment, and care among patients within Emory Healthcare by developing a model of care that can be replicated and sustained within health systems across the country. In the development, implementation, evaluation, and dissemination of the multi- component, multi-level interventions we will rely heavily on a community-engaged approach at all stages of implementation. Our central hypothesis is that with substantial guidance from a Community Advisory Board, comprehensive systems change implemented through an anti-racism lens will improve access to all steps of care along the CKD continuum among African American patients, thereby decreasing existing racial inequities. In close collaboration with the U01 Research Coordinating Center, we propose these aims: 1. Apply PHCRP to develop multi-level, multi-component interventions that target patient & provider outcomes 2. Implement multi-level, multi-component interventions across primary care and acute care access points, nephrology, and dialysis care using the six components of the CCM and PHCRP as organizing frameworks 3. Using a quasi-experimental interrupted time series design, determine the effectiveness of the interventions on primary outcomes analyzed at the level of patients and provider type 4. Evaluate implementation and support dissemination of the multi-level, multi-component interventions using the extended RE-AIM framework to assess Reach, Effectiveness, Adoption, Implementation, and Maintenance/Sustainability from a health equity lens.

抽象的晚期慢性肾病 (CKD) 治疗、护理和患者结果方面的种族差异深刻、持久、普遍。尽管有大量研究将结构性种族主义与一系列健康结果，直到最近，人们才开始关注种族主义在推动健康方面的作用。记录了 CKD 中的不平等现象。有效的 CKD 治疗和护理可以改善生活质量，减少需求对于已故供体移植，降低同种异体移植失败的可能性，并改善长期患者的状况生存；然而，由于结构性种族主义，这条护理道路上的每个点都存在种族差异。协作慢性病护理模型 (CCM) 提供了一个完善的多层次框架来组织卫生系统，以最大限度地提高 CKD 等慢性病患者的治疗效果；然而，就其本身而言，它未能关注结构性种族主义的作用。我们提出多层次、多组成部分的干预措施在新的创新框架下推动系统性变革：我们将应用公共卫生的四个重点 Critical Race Praxis (PHCRP)，一个通过反种族主义视角解决变革的公共卫生框架， CCM 的六个组成部分影响初级保健和急症护理接入点的 CKD 护理，肾脏病学和透析护理机构。通过这种方式，我们建议重新设计埃默里大学的结构医疗保健可减轻结构性种族主义对 CKD 不平等的影响。我们的长期目标是消除患者在 CKD 进展、治疗和护理方面的种族不平等在埃默里医疗保健公司内部，开发一种可以在健康领域复制和维持的护理模式全国各地的系统。在制定、实施、评估和传播多方我们将在各个阶段严重依赖社区参与的方法执行。我们的中心假设是，在社区咨询委员会的大力指导下，通过反种族主义视角实施的全面系统变革将改善获得所有步骤的机会非洲裔美国患者的 CKD 连续体护理，从而减少现有的种族不平等。通过与 U01 研究协调中心的密切合作，我们提出以下目标： 1. 应用 PHCRP 制定针对患者和提供者结果的多层次、多组成部分的干预措施 2. 在初级保健和急症护理接入点实施多层次、多组成部分的干预措施，使用 CCM 和 PHCRP 的六个组成部分作为组织框架的肾病学和透析护理 3. 使用准实验中断时间序列设计，确定干预措施的有效性在患者和提供者类型层面分析的主要结果 4. 评估实施情况并支持传播多层次、多组成部分的干预措施扩展的 RE-AIM 框架，用于评估范围、有效性、采用、实施和从健康公平的角度来看维护/可持续性。