Telemedicine for Evaluation and Counseling of Living Kidney Donor Candidates

用于活体肾脏捐赠者候选者评估和咨询的远程医疗

• 批准号: 10462758
• 负责人: Fawaz Al Ammary
• 金额: $ 8.06万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10462758
• 关键词: Adoption; Ambulatory Care Facilities; Award; Caring; Client satisfaction; Clinic Visits; Clinical Trials Design; Collection; Complex; Consensus; Counseling; Data; Enrollment; Ensure; Ethnic Origin; Evaluation; Expert Opinion; Feedback; Focus Groups; Funding; Future; Geography; Goals; Image; Improve Access; Intervention; Intervention Trial; Interview; Kidney; Kidney Failure; Kidney Transplantation; Knowledge; Laboratories; Living Donors; Logistics; Medical; Medical History; Methods; Nephrectomy; Outcome; Participant; Patients; Perception; Persons; Phase; Primary Health Care; Process; Protocols documentation; Published Comment; Qualitative Research; Questionnaires; Race; Randomized Clinical Trials; Reporting; Research; Research Methodology; Sampling; Screening Result; Structure; Surveys; Telemedicine; Time; Translating; Visit; Work; base; care coordination; design; digital intervention; effectiveness testing; experience; improved; innovation; living kidney donor; multidisciplinary; pandemic disease; pilot test; preference; programs; satisfaction; screening; social; transplant centers; video visit

PROJECT SUMMARY Nearly 100,000 patients with kidney failure in the US await kidney transplantation. Living donation reduces the wait and offers superior survival compared with deceased donation. Yet only 6,000 living kidney donations are achieved every year with a substantial decline in donation among biologically related donors in across race/ethnicity. While prior programs were associated with a 6-fold increase in donor referral, efforts to convert donor candidates to donor nephrectomy have been largely unsuccessful. Access to a transplant center is a key barrier to engagement of donor candidates. Alas, the pandemic has amplified this existing barrier. Living kidney donor evaluation is a complex multiphase process that includes activities over approximately one year. We have previously reported that two-thirds of referred persons are deemed medically ineligible donors after reviewing medical history and/or laboratory screening results. Of the one-third who are deemed eligible donor candidates, only 54% complete donor evaluation and counseling (of whom 58% ultimately donate), whereas 35% cannot proceed to complete this initial outpatient clinic visit due to non-medical (personal, social, and arrangement) reasons. The initial outpatient clinic visit is thus a bottleneck as it involves the first obligatory trip to an in-person visit where access to a transplant center becomes a barrier for willing candidates facing geographic, financial, or logistics challenges to come for their initial in-person evaluations. Efforts to promote engagement of kidney donor candidates are needed. Telemedicine via synchronous video visits can facilitate coordination of care in the donor evaluation process. Donor evaluation may become more accessible, efficient, and convenient. The rapid adoption of telemedicine during the pandemic has created opportunities and challenges. In our national survey of US transplant centers, we found that 81% reported telemedicine challenges related to structure and processes of care. In primary care studies, telemedicine video visits have achieved high levels of patient satisfaction and similar outcomes compared to in-person visits. A knowledge gap exists regarding how donor candidates perceive telemedicine in care coordination, and how to best tailor telemedicine care coordination in donor evaluation. Our scientifically goal is to integrate a telemedicine care coordination intervention into the donor evaluation process to enhance engagement of donor candidates and support completion of their evaluation. This award will allow Dr. Al Ammary the protected time to complete his proposed research. Findings of this work will fill a knowledge gap about the new paradigm using telemedicine for donor evaluation and offer preliminary data for an R01-funded randomized clinical trial to test the effectiveness of telemedicine care coordination in increasing living donation and support his transition to independence.

项目摘要 美国有近10万名肾衰竭患者等待肾移植。活体捐赠减少了 等待，并提供上级生存比死者捐赠。然而，只有6,000名活体肾脏捐赠者 每年都实现了这一目标，在生物学相关的捐赠者中， 种族/民族。虽然先前的计划与捐助者转介增加6倍有关，但努力转换 供者肾切除术的供者候选者大多不成功。进入移植中心是关键 捐助者候选人参与的障碍。遗憾的是，大流行病扩大了这一现有障碍。 活体肾脏供体评估是一个复杂的多阶段过程，包括大约一个月的活动。 年我们以前曾报道过，三分之二的转介人被认为是医学上不合格的捐赠者 在审查病史和/或实验室筛查结果后。在被认为有资格的三分之一中 只有54%的捐赠者完成了捐赠者评估和咨询（其中58%最终捐赠）， 而35%的人由于非医疗原因（个人，社会， （安排）原因。因此，初次门诊就诊是一个瓶颈，因为它涉及到第一次强制性检查。 前往一个人访问，进入移植中心成为一个障碍，愿意候选人面临 地理、财务或后勤方面的挑战。努力促进 需要肾脏捐赠者候选人的参与。通过同步视频访问的远程医疗可以促进 在捐助者评估过程中协调护理工作。捐助者评价可能变得更容易获得、更有效， 而且方便。在大流行期间迅速采用远程医疗创造了机会， 挑战在我们对美国移植中心的全国调查中，我们发现81%的人报告了远程医疗， 与护理结构和过程有关的挑战。在初级保健研究中，远程医疗视频访问 实现了高水平的患者满意度和类似的结果相比，在人的访问。知识 在捐助候选人如何看待护理协调中的远程医疗以及如何最好地调整 捐助者评价中的远程医疗护理协调。 我们的科学目标是将远程医疗护理协调干预纳入供体评估 加强捐助候选人的参与并支持完成对他们的评价。这个奖项 将允许阿尔·安玛丽博士在受保护的时间内完成他的研究计划。这项工作的结果将填补一个 关于利用远程医疗进行捐助者评价的新模式的知识差距，并提供初步数据， 一项由R 01资助的随机临床试验，旨在测试远程医疗护理协调在增加 支持他的独立过渡。