Health system outreach to eliminate disparities in living kidney transplants

项目总结 尽管他们的终末期肾病发病率比 白人和非裔美国人早期活体肾移植(LDKT)的比率较低， 终末期肾病的最佳治疗方法。接受LDKT的差异有 在过去的十年里恶化了。至少四个关键路障阻碍了患者的旅程 获得LDKT的途径，包括他们缺乏对其需要LDKT的认识；贫穷 对LDKT的了解以及与家人和医生讨论LDKT的困难；罕见或 移植早期评估的转诊缓慢；难以完成多步骤 移植评估流程。非裔美国人可能更频繁地面临这些关键问题 与其他人相比，这是一个障碍。同时严格研究干预措施 解决这些关键障碍是不存在的。卫生系统有许多能力 (包括信息和人力资源)，可以创造性地利用这些资源来解决 导致不平等的多个关键障碍阻碍了LDKT的发展。然而，研究量化 利用和协调卫生系统资源的干预措施的有效性 尚未进行缓解LDKT差异的研究，留下了证据空白。我们建议 研究一种创新的干预措施--“卫生系统监测和推广”，旨在 克服导致LDKT差异的多个障碍。我们将进行一次比较 量化“卫生系统监察和外展”成效的试验 与通常的护理相比，减少LDKT中的种族差异。我们的研究将在 美国南部的两个大型卫生系统，那里的肾脏疾病差异非常大 流行，也是最迫切需要LDKT的地方。卫生系统监测和 外联活动将把监测登记纳入电子健康信息系统，以 及早公平地确定先发制人或早期LDKT的所有潜在候选者 患者的实验室数据和经过验证的计算机生成的肾脏疾病进展风险 预测算法。移植社会工作者和协调员，他们已经嵌入到 移植团队，将与确定的潜在LDKT候选人进行接触，以帮助他们解决 背景因素(包括教育、社会、物流和导航需求) 通往LDKT的路障。我们的两个主要结果将衡量患者的开始和完成 使用卫生系统记录进行肾移植评估。我们还将测量 我们的导航支持在肾移植评估过程中的有效性。本研究 将提供必要的证据，以消除南方和全国各地的LDKT差距。

PROJECT SUMMARY Despite their nearly four-fold greater incidence of end stage kidney disease compared to Whites, African Americans have lower rates of early living donor kidney transplantation (LDKT), an optimal treatment for end stage kidney disease. Disparities in receipt of LDKT have worsened over the past decade. At least four critical roadblocks hinder patients’ journey along the path to receiving LDKTs, including their lack of awareness of their need for LDKT; poor knowledge of LDKT and difficulties discussing LDKT with family and physicians; infrequent or sluggish referrals for early transplant evaluations; and difficulty completing the multi-step transplant evaluation process. African Americans may more frequently face these critical roadblocks when compared to others. Rigorously studied interventions simultaneously addressing these critical roadblocks do not exist. Health systems have numerous capabilities (including information and staffing resources) that could be creatively leveraged to address the multiple critical roadblocks to LDKT that contribute to disparities. However, studies quantifying the effectiveness of interventions which harness and coordinate health system resources to mitigate LDKT disparities have not been performed, leaving an evidence gap. We propose to study an innovative intervention, “Health System Surveillance and Outreach,” designed to overcome multiple roadblocks which lead to LDKT disparities. We will conduct a comparative effectiveness trial to quantify the effectiveness of ‘Health System Surveillance and Outreach’ compared to usual care to mitigate race disparities in LDKT. Our study will be conducted within two large health systems in the Southern US, where disparities in kidney disease are extremely prevalent, and where LDKT is most desperately needed. Health System Surveillance and Outreach will integrate a surveillance registry into electronic health information systems to identify all potential candidates for pre-emptive or early LDKT early and equitably by using patients’ laboratory data and a validated computer-generated kidney disease progression risk prediction algorithm. Transplant social workers and coordinators, who are already embedded in transplant teams, will ‘reach out’ to identified potential LDKT candidates to help them address contextual factors (including educational, social, logistical, and navigation needs) that pose roadblocks to LDKT. Our two primary outcomes will measure patients’ initiation and completion of kidney transplant evaluations using health system records. We will also measure the effectiveness of our navigation support on the kidney transplant evaluation process. This study will provide evidence needed to eliminate LDKT disparities in the South and across the nation.