Intensive Patient Referral and Education Program prior to Renal Replacement Therapy (iPREP RRT)

项目摘要 患有慢性肾脏疾病(CKD)的非裔美国人在医疗质量方面存在差异， 终末期肾病(ESRD)的自我护理和准备。耐心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终末期肾病和肾脏疾病 替代疗法(RRT)治疗选择。住院治疗是一次“错失的机会” CKD教育和ESRD计划，帮助患者对其护理做出明智的选择 他们的喜好。许多患者在开始透析后的三个月内住院。医院还 捕捉那些在其他方面与医疗系统联系不佳的患者。在之前的工作中，我们的团队开发了 并实施了Prep RRT，这是一种为住院患者量身定做的多模式患者教育干预 患有晚期CKD的非裔美国患者使用种族和谐的面对面教育者和识字- 敏感的教育材料。我们的干预在增加患者知识方面是可行和有效的，但 力度还不够大，不足以改变行为。因此，我们使用了一个经过调整的12周有效的门诊患者 教育计划，以补充我们的住院试点计划，以增加患者知识，提高自我 关爱行为，强化关爱联动。在这项建议中，我们将进行随机试验，以测试 强化预备RRT干预对晚期非裔美国人住院患者的影响 慢性肾脏病患者接受基于医院的干预和12周的基于社区的干预。我们寻求 增加患者知识、自我效能、自我管理行为、寻求健康行为、RRT计划 和血压控制。我们组建了一支强大的团队，在CKD健康差距、医院- 以社区为基础的干预措施，随机试验设计，文化定制的患者教育，以及 以理论为基础的干预发展。在成功完成我们的目标后，我们将开发出一种 有效的干预措施，将通过改善患者的CKD相关知识、行为和 关心。我们还将有能力在不同环境中传播干预并调整干预 适用于其他患者群体。

PROJECT ABSTRACT 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 about renal replacement therapy (RRT) 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 PREP RRT, 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 in increasing patient knowledge but was not intensive enough to change behavior. Thus, we used adapted an 12- week effective outpatient patient education program to complement our in-patient pilot program to increase patient knowledge, improve self- care behavior and strengthen linkage to care. In this proposal, we will conduct a randomized trial to test the effectiveness of the intensive PREP RRT intervention for hospitalized African American patients with advanced CKD with both a hospital-based intervention and a 12 week community-based intervention. We seek to increase patient knowledge, self-efficacy, self-management behavior, health seeking behavior, RRT planning and blood pressure control. We have assembled a strong team with skills in CKD health disparities, hospital- based and community-based interventions, randomized trial design, culturally-tailored patient-education, and theory-based intervention development. After successful completion of our aims, we will have developed an effective intervention that will reduce disparities by improving patient's CKD- related knowledge, behavior and care. We will also have the ability to disseminate the intervention across settings and to adapt the intervention for other patient populations.