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

项目摘要 患有慢性肾病（CKD）的非裔美国人在医疗质量方面存在差异， 自我护理和终末期肾病（ESRD）的准备。患者教育可以帮助非洲裔美国人 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。住院代表“错失了提供CKD教育的机会”， ESRD计划帮助患者根据自己的偏好做出明智的护理选择。许多 患者在透析开始后三个月内住院。医院也会抓住那些 与医疗系统没有很好的联系在之前的工作中，我们的团队开发并实现了一个 为住院的非裔美国人患者提供文化定制的多模态患者教育干预 使用种族一致的面对面教育者和识字敏感的教育材料来治疗晚期CKD。我们 干预是可行和有效的。然而，使用一个人的病人教育者是资源密集型的。在 根据这项建议，我们将开发一种互动的、计算机自适应的患者教育干预， 从方便的电子媒体与病人为中心的好处，在人的教育。我们将 还确定了计算机适应性教育在提高住院非洲人知识方面的功效， 与常规治疗相比，美国晚期慢性CKD患者。我们组建了一支强大的队伍 在慢性肾脏疾病的健康差异，以医院为基础的干预，文化定制的患者， 教育，动机访谈，以及基于技术的干预措施，用于患者教育。R21飞行员 和可行性试验将使该小组能够建立和测试的有效性和可接受性的计算机自适应 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.