Multi-level Factors that Influence Dialysis Facilities' Assessments of Patient Suitability for Transplantation

影响透析机构评估患者移植适宜性的多层次因素

• 批准号: 10368083
• 负责人: Adam Steven Wilk
• 金额: $ 15.04万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10368083
• 关键词: Address; Administrator; Advocate; Affect; Anxiety; Area; Assessment tool; Caring; Characteristics; Clinical; Communities; Complex; Consolidated Framework for Implementation Research; Cross-Sectional Studies; Data; Data Collection; Data Set; Decision Aid; Development; Dialysis procedure; End stage renal failure; Evaluation; Fostering; Future; Goals; Grant; Health Services; Incidence; Income; Individual; Intervention; Interview; Investigation; Joints; Judgment; K-Series Research Career Programs; Kidney Diseases; Kidney Transplantation; Knowledge; Lead; Link; Low income; Measurable; Measures; Medical; Mentored Research Scientist Development Award; Mentors; Mentorship; Minor; National Institute of Diabetes and Digestive and Kidney Diseases; Nephrology; Obesity; Outcome; Patient-Focused Outcomes; Patients; Policies; Population; Process; Process Assessment; Protocols documentation; Provider; Psychosocial Assessment and Care; Public Health Schools; Qualitative Methods; Quality of life; Reporting; Research; Research Methodology; Research Personnel; Resources; Shapes; Standardization; Stress; Structure; Suggestion; Surveys; Team Process; Testing; Time; Training; Transplant Recipients; Transplantation; Treatment outcome; Uncertainty; Universities; Validation; Waiting Lists; Weighing patient; Wrestling; Writing; black patient; care providers; career; cognitive load; complex chronic conditions; contextual factors; design; disease diagnosis; ethnic minority; ethnic minority population; experience; health disparity; implementation framework; improved; interest; optimal treatments; peer; pressure; professor; provider factors; racial and ethnic; racial and ethnic disparities; relative cost; response; skills; socioeconomic disparity; theories; tool; training opportunity; transplant centers

Project Summary/Abstract For most patients with end-stage renal disease (ESRD), kidney transplantation is the optimal treatment. Underserved racial/ethnic minority and low-income individuals have a greater burden of ESRD (higher incidence and more rapid progression), yet they have much poorer access to transplant. Before patients are considered for waitlisting at a transplant center, dialysis facility teams perform complex medical and psychosocial assessments of patients' suitability for transplant and decide whether to refer them to a transplant center for full evaluation. These pre-referral assessment processes, which vary widely across clinical teams, have been identified as among the most important potential drivers of downstream disparities in transplant waitlisting and receipt. The objective of this application for a NIDDK Mentored Research Scientist Development Award (K01) is to support an assistant professor at the Emory University Rollins School of Public Health to become an independent health services researcher fully equipped with the skills to build understanding of these patient assessment processes and to improve their treatment outcomes. To that end, this K01 award will provide training in clinical nephrology, qualitative and survey research methods, implementation science frameworks, and grant-writing. The research aims are designed to reinforce and apply these new skills and concepts in an investigation of dialysis facilities' pre-referral patient assessment processes. Specifically, the K01's research objective is to use rigorous qualitative and survey research methods to elucidate the measurable and modifiable provider-level constructs of cognitive load (stress, time pressure, disruptions) and uncertainty tolerance (anxiety or worry in response to uncertainty) and their impact on disparities in pre-referral assessments within their dialysis facility context. Aim 1 will use qualitative methods to explore how provider- level factors (e.g., cognitive load, uncertainty tolerance) and multi-level contextual factors (e.g., facility-level standard protocols, local transplant center policies) shape dialysis facility teams' processes for pre-referral patient assessment. Aim 2 will develop and validate a survey to quantify staff, dialysis facility, and community characteristics in the context of pre-referral assessments using a survey pilot and a rigorous modified Delphi approach. Aim 3 will conduct a survey of n≈2000 dialysis facility staff across 13 states and use linked data on patient transplant evaluation outcomes (referral, evaluation start, and waitlisting) to assess how staff cognitive load and uncertainty tolerance are related to racial/ethnic and socioeconomic disparities in transplant access as well as dialysis facility and community characteristics. The protected time, resources, and mentoring available through this career development award will enable Dr. Adam Wilk to emerge as an independent and leading researcher, conducting groundbreaking survey research and fostering the development and implementation of multi-level interventions to address barriers in access to transplant or other preferred treatments for underserved patients with kidney disease and other complex chronic conditions.

项目概要/摘要 对于大多数终末期肾病（ESRD）患者来说，肾移植是最佳治疗方法。 服务不足的少数族裔和低收入个人的 ESRD 负担更大（更高 发生率和进展更快），但他们获得移植的机会要少得多。在患者被 考虑在移植中心等候，透析设施团队执行复杂的医疗和 对患者是否适合移植进行心理社会评估并决定是否将其转诊至移植 中心进行全面评估。这些转诊前评估流程在不同的临床团队中差异很大， 已被确定为移植下游差异的最重要的潜在驱动因素之一 等候名单和收据。此应用程序的目标是 NIDDK 指导研究科学家发展 奖项（K01）旨在支持埃默里大学罗林斯公共卫生学院的助理教授 成为一名独立的卫生服务研究人员，完全具备建立对以下问题的理解的技能： 这些患者评估过程并改善他们的治疗结果。为此，本次K01奖将 提供临床肾病学、定性和调查研究方法、实施科学方面的培训 框架和拨款写作。研究目的旨在加强和应用这些新技能 透析设施转诊前患者评估流程调查中的概念。具体来说， K01的研究目标是使用严格的定性和调查研究方法来阐明 可测量和可修改的提供者级认知负荷结构（压力、时间压力、干扰）和 不确定性容忍度（对不确定性的焦虑或担忧）及其对预转诊差异的影响 在其透析设施范围内进行评估。目标 1 将使用定性方法来探索提供商如何- 水平因素（例如，认知负荷、不确定性容忍度）和多水平背景因素（例如，设施水平 标准协议、当地移植中心政策）塑造透析设施团队的预转诊流程 患者评估。目标 2 将制定并验证一项调查，以量化员工、透析设施和社区 使用调查试点和严格修改的德尔菲法进行转诊前评估的特征 方法。目标 3 将对 13 个州的约 2000 名透析设施工作人员进行调查，并使用相关数据 患者移植评估结果（转诊、评估开始和等候名单），以评估工作人员的认知情况 负荷和不确定性容忍度与移植获得方面的种族/民族和社会经济差异有关 以及透析设施和社区特征。受保护的时间、资源和指导 通过该职业发展奖，Adam Wilk 博士将成为一名独立且 领先的研究人员，进行开创性的调查研究并促进发展和 实施多层次干预措施，以解决获得移植或其他优先选择的障碍 为患有肾病和其他复杂慢性病的患者提供治疗服务。