NAVIGATE Kidney: A Multi-Level Intervention to Reduce Kidney Health Disparities

NAVIGATE Kidney：减少肾脏健康差异的多层次干预措施

基本信息

批准号：
10742130
负责人：
Lilia Cervantes
金额：
$ 80.49万
依托单位：
UNIVERSITY OF COLORADO DENVER
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/10742130
关键词：
Address American American Indians Arteriovenous fistula Blood Vessels Caring Catheters Chronic Kidney Failure Colorado Communities Community Health Aides Complex Conflict (Psychology)Cost Effectiveness Analysis Data Dialysis procedure Discrimination Disparity Education Effectiveness Ensure Equity Ethnic Population Evaluation Face Family Funding Gender Geography Goals Health Health Care Sector Health Insurance Health Policy Hemodialysis Hispanic Populations Home Hospitalization Improve Access Incentives Individual Infection Intervention Kidney Kidney Diseases Kidney Failure Kidney Transplantation Language Latino Latino Population Latinx Latinx population Learning Measures Methods Modeling National Institute of Diabetes and Digestive and Kidney Diseases National Institute on Minority Health and Health Disparities New Mexico Organizational Policy Participant Patient-Centered Care Patient-Focused Outcomes Patients Peritoneal Dialysis Phenotype Policies Policy Maker Poverty Practical Robust Implementation and Sustainability Model Procedures Provider Randomized Randomized, Controlled Trials Recommendation Renal Replacement Therapy Research Schedule Structural Racism Structure Testing Transplant Recipients Transplantation United States Centers for Medicare and Medicaid Services Venous Visit Waiting Lists Work arteriovenous graft community engaged research contextual factors cost cost effectiveness cost-effectiveness evaluation distrust economic evaluation effectiveness evaluation effectiveness outcome ethnic minority experience food environment health disparity health equity health literacy high risk implementation context implementation framework implementation outcomes improved innovation intervention participants member mortality mortality risk payment person centered primary outcome racial minority racial population recruit response secondary outcome shared decision making social health determinants standard care trial comparing

项目摘要

PROJECT SUMMARY/ ABSTRACT Latinx (gender-inclusive term; includes Hispanics, Latino/a) experience a faster progression from chronic kidney disease (CKD) to kidney failure and face a disproportionate burden of structural racism and discrimination that contribute to kidney health disparities compared to non-Latinx Whites. Latinx individuals constitute the racial and ethnic group most likely to start dialysis with a central venous catheter. Compared to non-Latinx Whites, they are less likely to start recommended kidney replacement therapy (KRT) such as home dialysis and kidney transplant. Reducing the number of individuals who start KRT with a central venous catheter is critical because it is associated with a higher risk of fatal infection, non-fatal infection, hospitalization, and mortality compared to permanent vascular access. The Advancing American Kidney Health Initiative, a 2019 Presidential executive order, aims to improve access and quality of person-centered KRT. In response, the Centers for Medicare and Medicaid Services (CMS) launched kidney value-based payment models to improve patient-centered care; however, these models do not address the structural racism that operates across socioecological levels faced by racial and ethnic minorities with CKD. Our community- partnered team assessed how structural racism operates across socioecological levels among Latinx with kidney disease and in partnership with community, developed and tested NAVIGATE-Kidney, a multi-level, language and culturally concordant community health worker (CHW) intervention for Latinx on hemodialysis. We propose to partner with our community steering committees (CSCs) in Colorado and New Mexico to refine, adapt, and test NAVIGATE-Kidney for Latinx individuals with CKD stage 4/5 (eGFR 15-29 mL/min/1.73m2) (Aim 1). We will determine the effectiveness of NAVIGATE-Kidney compared to standard care by conducting a patient-level randomized controlled trial in 448 Latinx with CKD stage 4/5 (Aim 2). Our primary hypothesis is that intervention participants will have a lower rate of central venous catheter use at KRT start (primary outcome). Our secondary hypothesis is that intervention participants will have a higher rate of optimal KRT starts (composite secondary outcome), higher patient activation, and lower decisional conflict (patient-centered outcomes). To provide the most compelling data that will address structural racism, we will assess contextual factors and implementation outcomes using the innovative PRISM (Practical Robust Implementation and Sustainable Model) framework which aligns with parameters that policymakers consider to advance health equity (Aim 3). We will conduct a comprehensive economic evaluation including a cost-effectiveness analysis of NAVIGATE-Kidney to inform policy change (Aim 4). All the proposed work will be conducted in partnership with our community steering committee and patient partners. We will set up CSC structures and procedures to ensure authentic partnership, goal-setting, shared decision-making, and language equity.

项目概要/摘要拉丁裔（包含性别的术语；包括西班牙裔、拉丁裔/a）从慢性病的进展更快肾病（CKD）到肾衰竭，并面临结构性种族主义和不成比例的负担与非拉丁裔白人相比，歧视导致肾脏健康差异。拉丁裔个人构成最有可能开始使用中心静脉导管进行透析的种族和民族群体。相比非拉丁裔白人，他们不太可能开始推荐的肾脏替代疗法 (KRT)，例如在家透析和肾移植。减少开始中心静脉 KRT 的人数导管至关重要，因为它与致命感染、非致命感染、与永久性血管通路相比，住院率和死亡率。不断进步的美国肾脏健康倡议是 2019 年总统行政命令，旨在改善以人为本的医疗服务的获取和质量 KRT。作为回应，医疗保险和医疗补助服务中心 (CMS) 推出了基于肾脏价值的改善以患者为中心的护理的支付模式；然而，这些模型并没有解决结构性种族主义该项目跨越患有 CKD 的少数种族和族裔所面临的社会生态层面。我们的社区- 合作团队评估了结构性种族主义如何在拉丁裔中跨社会生态层面运作与社区合作，开发并测试了 NAVIGATE-Kidney，这是一种多层次、社区卫生工作者 (CHW) 对拉丁裔血液透析进行语言和文化一致的干预。我们建议与科罗拉多州和新墨西哥州的社区指导委员会 (CSC) 合作，以完善、适应并测试 NAVIGATE-Kidney，适用于 CKD 4/5 期的拉丁裔个体（eGFR 15-29 mL/min/1.73m2）（目标 1）。我们将通过进行一项试验来确定 NAVIGATE-Kidney 与标准护理相比的有效性在 448 名 CKD 4/5 期拉丁裔患者中进行的患者水平随机对照试验（目标 2）。我们的主要假设是干预参与者在 KRT 开始时使用中心静脉导管的比率较低（主要结果）。我们的次要假设是干预参与者的最佳 KRT 率更高启动（复合次要结果）、更高的患者积极性和更低的决策冲突（以患者为中心）结果）。为了提供解决结构性种族主义的最令人信服的数据，我们将评估情境使用创新的 PRISM（实用稳健实施和可持续模型）框架，与政策制定者考虑的促进健康的参数相一致公平（目标 3）。我们将进行全面的经济评估，包括成本效益分析 NAVIGATE-Kidney 的信息通报政策变化（目标 4）。所有拟议的工作都将合作进行与我们的社区指导委员会和患者合作伙伴一起。我们将建立 CSC 结构和程序确保真正的伙伴关系、目标设定、共同决策和语言平等。