Impact of Navigators on Completion of Steps in the Kidney Transplant Process: A Randomized, Controlled Trial
Impact of Navigators on Completion of Steps in the Kidney Transplant Process: A Randomized, Controlled Trial
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DOI：
10.2215/cjn.11731111
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发表时间：
2012-10-01
影响因子：
9.8
通讯作者：
Sehgal, Ashwini R.
中科院分区：
文献类型：
--
作者：
Sullivan, Catherine;Leon, Janeen B.;Sehgal, Ashwini R.
背景和目的许多ESRD患者，特别是少数民族和妇女，在完成获得移植所需的步骤时面临障碍。这八个顺序步骤如下：医疗适宜性，对移植的兴趣，转介到移植中心，首次访问中心，移植检查，成功的候选人，等待名单或确定活体供体，接受移植。这项研究试图确定导航器对完成步骤的影响。设计、设置、参与者和测量在俄亥俄州23家血液透析机构进行的聚类随机对照试验。在2009年1月至2009年8月期间招募了167名患者，并随访了长达24个月或直到2011年2月研究结束。经过训练的肾移植受者每月与干预参与者（n=92）会面，确定他们在移植过程中的步骤，并提供量身定制的信息和帮助完成步骤。对照组（n=75）继续接受常规治疗。主要结果是完成移植过程步骤的数量。结果两组患者的起始步数无显著差异。到试验结束时，干预参与者完成的步数是对照组的两倍多（3.5步对1.6步；差异1.9步；95%置信区间1.3-2.5步）。干预对步骤完成的影响在种族和性别亚组中相似。结论：使用训练有素的移植受者作为导航员可提高移植过程步骤的完成度。Clin J Am Soc。中国生物医学工程学报（英文版），2012。doi: 10.2215 / CJN.11731111
Background and objectives Many patients with ESRD, particularly minorities and women, face barriers in completing the steps required to obtain a transplant. These eight sequential steps are as follows: medical suitability, interest in transplant, referral to a transplant center, first visit to center, transplant workup, successful candidate, waiting list or identify living donor, and receive transplant. This study sought to determine the effect of navigators on completion of steps.Design, setting, participants, & measurements Cluster randomized, controlled trial at 23 Ohio hemodialysis facilities. One hundred sixty-seven patients were recruited between January 2009 and August 2009 and were followed for up to 24 months or until study end in February 2011. Trained kidney transplant recipients met monthly with intervention participants (n=92), determined their step in the transplant process, and provided tailored information and assistance in completing the step. Control participants (n=75) continued to receive usual care. The primary outcome was the number of transplant process steps completed.Results Starting step did not significantly differ between the two groups. By the end of the trial, intervention participants completed more than twice as many steps as control participants (3.5 versus 1.6 steps; difference, 1.9 steps; 95% confidence interval, 1.3-2.5 steps). The effect of the intervention on step completion was similar across race and sex subgroups.Conclusions Use of trained transplant recipients as navigators resulted in increased completion of transplant process steps. Clin J Am Soc. Nephrol 7: 1639-1645, 2012. doi: 10.2215/CJN.11731111