CommunityRx – Chronic Kidney Disease (CRx-CKD)” An EMR-integrated community resources referral intervention to address structural racism and kidney health disparities in rural North Carolina

CommunityRx — 慢性肾脏病 (CRx-CKD) — 一项与 EMR 整合的社区资源转诊干预措施，旨在解决北卡罗来纳州农村地区的结构性种族主义和肾脏健康差异

• 批准号: 10743421
• 负责人: Gaurav J Dave
• 金额: $ 76.19万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 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/10743421
• 关键词: Academy; Address; Adult; Advocate; Affect; African American; African American population; Albuminuria; Algorithms; Attenuated; Behavior; Black Populations; Black race; Blood Glucose; Body Weight decreased; Body mass index; Cardiovascular Diseases; Caregivers; Caring; Censuses; Chicago; Chronic Kidney Failure; Clinic; Clinical; Communities; Consolidated Framework for Implementation Research; County; Death Rate; Development; Diabetes Mellitus; Disease Management; Disease Progression; Disparity; Effectiveness; Electronic Health Record; Eligibility Determination; Ensure; Environmental Exposure; Equity; Fostering; Glucose; Goals; Health; Health Personnel; High Prevalence; Home; Hyperlipidemia; Hypertension; Individual; Inequity; Infrastructure; Intervention; Kidney; Kidney Diseases; Kidney Failure; Medical; Modeling; North Carolina; Obesity; Outcome; Pathway Analysis; Patients; Persons; Policies; Poverty; Prevention; Process; Productivity; Public Health; Randomized, Controlled Trials; Renal Replacement Therapy; Research; Research Personnel; Resources; Rural; Rural Community; Science; Services; Structural Racism; Structure; Survey Methodology; System; Telephone; Testing; Text Messaging; Youth; access disparities; arm; blood lipid; blood pressure control; care coordination; care systems; community building; community clinic; cost effectiveness; disease disparity; disparities in morbidity; disparity reduction; eHealth; effectiveness testing; effectiveness/implementation study; evidence base; experience; foot; fortification; glomerular filtration; health care disparity; health disparity; health equity; health outcome disparity; hospitalization rates; implementation context; implementation science; improved outcome; integrated care; model building; multidisciplinary; multiple chronic conditions; novel; organizational readiness; point of care; post intervention; premature; primary care clinic; primary outcome; programs; racism; rural health clinic; rural setting; rurality; secondary outcome; segregation; social; treatment as usual; trend

Project Summary/Abstract Mitigating progressive chronic kidney disease (CKD) to avoid kidney failure is well known -- management of CKD and its multimorbidity (hypertension, diabetes, obesity, and cardiovascular disease). Yet unequal access to and utilization of quality medical and social resources present a significant and under-addressed barrier to optimal management, especially in rural settings. As advocated by the National Academies, we propose to address the endemic effects of structural racism and systemic drivers of health by using an intervention that integrates medical with social care for African Americans adults in rural eastern North Carolina. The intervention, CommunityRx (CRx), systematically matches people to nearby community resources using evidence-based algorithms at the point of care with a health care provider. CRx utilizes a three- pronged approach to address integrated care among patients and caregivers: (a) comprehensive, ongoing assessment of community resources (eligibility, capacity, quality) using feet-on-the street (see Meaningful Active Productive Science in Service to Communities (MAPSCorps) below) and phone survey methods; (b) integration of a simple automatic resource referral process into routine, Electronic Health Record (EHR)-based clinical workflows; and (c) availability of a community resource navigator. CRx for CKD (CRx-CKD) is an application of this infrastructural approach to address CKD multimorbidity. Our community-engaged and multidisciplinary health equity research team will leverage our infrastructural intervention and implementation science expertise to test the effects of CRx-CKD through three related aims. Aim 1 will contextualize implementation and effectiveness of a rural infrastructural integrated care intervention by (a) building an inclusive model with system science to describe how structural racism affects CKD progress on and its mitigation through integrated care; and (b) conducting a network analysis to evaluate structures of clinic-community connectivity. Aim 2 will optimize Crx-CKD implementation through the Consolidated Framework of Implementation Research to ensure organizational readiness, fidelity, and acceptability. With aim 3, we will test the effectiveness of the CRx-CKD intervention with a pragmatic cluster randomized controlled trial at the clinic level. Three hundred seventy-five African American individuals with CKD multimorbidity at the intervention clinics will be compared to 375 individuals at usual care clinics for the primary outcome of reduction of the glomerular filtration slope decline and reduction of albuminuria; other, secondary outcomes include control of blood pressure, control of blood sugar, weight reduction, and blood lipid management.

项目摘要/摘要 众所周知，缓解进行性慢性肾脏疾病（CKD）以避免肾衰竭 - CKD的管理及其多种病毒（高血压，糖尿病，肥胖和心血管 疾病）。然而，优质医学和社会资源的不平等访问和利用呈现 最佳管理的重大且已完成的障碍，尤其是在农村环境中。作为 由国家学院提倡，我们建议解决结构性的流行作用 种族主义和健康驱动因素通过使用将医疗与社会融合的干预措施 照顾北卡罗来纳州东部农村地区的非洲裔美国人。干预， CommunityRx（CRX），系统地将人们与附近的社区资源相匹配 医疗保健提供者的护理点基于证据的算法。 CRX使用三 解决患者和看护者之间综合护理的统治方法：（a） 使用全面的，持续的社区资源评估（资格，能力，质量） 街上的脚（请参阅为社区服务的有意义的主动生产科学 （mapscorps）和电话调查方法； （b）简单自动资源的集成 转介过程为常规，电子健康记录（EHR）的临床工作流程； （c） 社区资源导航器的可用性。 CKD（CRX-CKD）的CRX是此应用 解决CKD多种病的基础设施方法。我们的社区参与 多学科健康公平研究团队将利用我们的基础设施干预和 实施科学专业知识，以测试CRX-CKD通过三个相关目标的影响。 AIM 1将在农村基础设施综合的实施和有效性上进行情境化。 通过（a）使用系统科学构建包容性模型的护理干预，以描述如何描述 结构性种族主义会影响CKD的进步及其通过综合护理的缓解； （b） 进行网络分析以评估临床社区连接的结构。 AIM 2意志 通过合并实施框架优化CRX-CKD实施 研究以确保组织准备，保真度和可接受性。使用AIM 3，我们将测试 用务实的簇随机控制的CRX-CKD干预的有效性 在诊所级别的试验。 CKD的三百七十五个非洲裔美国人 将在干预诊所的多种病态与常规护理诊所的375个人进行比较 为了减少肾小球滤过斜率下降和减少的主要结果 蛋白尿；其他次要结果包括控制血压，控制血压 糖，减轻体重和血脂管理。