A pilot to develop and test an Interactive Computer-adaptive Chronic Kidney Disease education program for hospitalized African American patients (I-C-CKD)

项目概要 患有慢性肾病 (CKD) 的非裔美国人在医疗护理质量方面存在差异， 自我护理和终末期肾病 (ESRD) 的准备。患者教育可以帮助非裔美国人 晚期 CKD 患者决定进行自我护理以延缓进展为 ESRD 并了解 ESRD 治疗选择。住院意味着“错失了提供 CKD 教育和治疗的机会” ESRD 计划帮助患者根据自己的喜好做出明智的护理选择。很多 患者在开始透析后三个月内住院。医院还捕获了以下患者 与医疗系统没有良好的联系。在之前的工作中，我们的团队开发并实施了 针对非裔美国住院患者的文化定制、多模式患者教育干预 使用种族一致的现场教育者和识字敏感的教育材料来进行高级 CKD。我们的 干预是可行且有效的。然而，使用现场患者教育者是资源密集型的。在 根据这项建议，我们将开发一种交互式的、计算机自适应的患者教育干预措施，该干预措施有利于 从电子媒体的便利性到现场教育者以患者为中心的好处。我们会 还确定了计算机适应性教育在提高住院非洲人的知识方面的功效 与常规护理相比，患有晚期慢性 CKD 的美国患者。我们组建了一支强大的团队 具有慢性肾病健康差异、基于医院的干预措施、针对患者文化量身定制的技能 教育、动机访谈和基于技术的患者教育干预措施。这位 R21 飞行员 可行性试验将使团队能够构建和测试计算机自适应系统的有效性和可接受性 在更大规模的随机 R01 水平研究之前进行教育干预。

PROJECT SUMMARY African Americans with chronic kidney disease (CKD) experience disparities in the quality of their medical care, self-care and preparation for end stage renal disease (ESRD). Patient education can help African American patients with advanced CKD decide to engage in self-care to delay progression to ESRD and to learn about ESRD treatment options. Hospitalization represents a “missed opportunity” to provide CKD education and ESRD planning to help patients make informed choices about their care that align with their preferences. Many patients are hospitalized within three months of dialysis initiation. The hospital also captures patients who are not otherwise well-linked to the medical system. In prior work, our team developed and implemented a culturally-tailored, multi-modality patient education intervention for hospitalized African American patients with advanced CKD using a racially concordant in-person educator and literacy-sensitive education materials. Our intervention was feasible and effective. However, using an in-person patient educator is resource-intensive. In this proposal, we will develop an interactive, computer adaptive patient education intervention that benefits from the convenience of electronic media with the patient-centered benefits of an in-person educator. We will also determine the efficacy of the computer-adaptive education in improving knowledge for hospitalized African American patients with advanced chronic CKD as compared to usual care. We have assembled a strong team with skills in chronic kidney disease health disparities, hospital-based interventions, culturally-tailored patient- education, motivational interviewing, and technology-based interventions for patient education. This R21 pilot and feasibility trial will enable the team to build and test the efficacy and acceptability of the computer-adaptive education intervention prior to a larger scale randomized R01-level study.