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

• 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
• 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

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 晚期慢性肾脏疾病（CKD）治疗，护理和患者预后的种族差异是 深刻，持久和普遍。尽管有大量研究将结构性种族主义与一系列 健康成果，直到最近才引起人们对种族主义在推动良好方面的作用的关注 记录了CKD的不平等。有效的CKD治疗和护理可以改善生活质量，减少需求 对于已故的供体移植，减少同种异体移植失败的可能性，并改善长期患者 生存；然而，由于结构性种族主义，沿着这一护理途径的每个点都存在种族差异。 协作慢性护理模型（CCM）提供了一个完善的多层框架 卫生系统为了最大程度地提高慢性疾病（例如CKD）患者的结局；然而， 仅凭它，它就无法关注结构性种族主义的作用。我们提出了多层次的多组分干预措施 在一个新的创新框架下激发系统性变化：我们将应用公共卫生的四个焦点 关键种族实践（PHCRP）是一种通过反种族主义镜头来解决变化的公共卫生框架， CCM的六个组件影响CKD护理在初级保健和急性护理访问点中， 肾脏病和透析护理环境。通过这种方式，我们建议重新设计Emory内的结构 医疗保健减轻结构种族主义对CKD不平等的影响。 我们的长期目标是消除患者中CKD进展，治疗和护理中的种族不平等 在Emory Healthcare内部开发一种可以在健康中复制和维持的护理模型， 全国各地的系统。在开发，实施，评估和传播中 组件，多层次干预措施，我们将在各个阶段都严重依赖社区参与的方法 执行。我们的中心假设是，在社区顾问委员会的大量指导下 通过反种族主义镜头实施的全面系统变化将改善对所有步骤的访问 非裔美国人患者的CKD连续体护理，从而减少了现有的种族不平等。 在与U01研究协调中心的密切合作中，我们提出了这些目标： 1。应用PHCRP来开发针对患者和提供者结果的多层次，多组分干预措施 2。在初级保健和急性护理访问点上实施多层次的多组分干预措施， 使用CCM和PHCRP的六个组成部分作为组织框架的肾脏病和透析护理 3。使用准实验中断的时间序列设计，确定干预措施的有效性 关于在患者和提供者类型水平分析的主要结果 4。使用使用多级，多组分干预措施的实施和支持传播 扩展的RE-AIM框架，以评估覆盖范围，有效性，采用，实施和 健康平等镜头的维护/可持续性。