Access to Kidney Transplantation in Minority Populations (AKT-MP)

项目总结/摘要 肾移植（KT）是终末期肾病（ESKD）的最佳治疗方法。它降低了死亡率， 提高生活质量，并且比透析花费更少。以前的研究表明， ESKD及其对弱势群体成员的待遇[例如，西班牙裔/拉丁裔（HL），美洲印第安人 (AI)低收入）。虽然HL和AI与非西班牙裔白人（WH）一样被称为KT，但他们更少 更有可能被列入等待名单或接受KT而不是WH。这些发现说明了研究重点的重要性 在转介接受KT后，评估过程中出现的差异，而不是转介本身。的KT 评估过程冗长、耗时且繁琐，需要患者完成许多 测试将提交给移植团队并接受KT。患者必须自己完成测试， 这要求他们负责一系列复杂的测试和专家提供者的后续访问。 大多数减少KT差异的努力都强调教育或改变透析患者的行为 没有被转介接受KT的人但这些办法并不能减轻评价过程的负担 于患者本身此外，教育患者并不能消除可能阻止患者接受治疗的外部障碍。 完成KT评估，尽管他们有最好的意图这样做。相反，改变护理的方式， 患者，通过改变KT评估过程对患者的要求，将显著降低KT 差距。拟议的研究将评估肾移植快速通道（KTFT），一个精简的KT 评估过程，或同行导航员（PN）谁是前KT患者，以帮助患者“导航”他们的方式 通过KT评估，可以帮助ESKD弱势患者克服移植列表的障碍。后 在文化和背景上适应这两种干预措施，我们将使用比较有效性（CER） 对398例ESKD患者进行一项实用的随机试验，以比较疗效和 两种方法在大学附属移植中心弱势群体中的有效性， 大型HL和AI ESKD患者人群，我们将比较结果与历史比较人群 （地方和国家）。我们将评估广泛实施的促进因素和障碍，并进行成本评估。 有效性分析尽管预期KTFT将比PN更有效，但KTFT也可能是有效的。 成本更高，需要移植中心的重大管理和临床变化，这可能是 不切实际的维护。此外，KTFT可能导致更多的患者矛盾心理，因为缩短的 评估期将给他们更少的时间来考虑他们的治疗方案。因此， 建议的研究是比较两种方法的有效性。最终，我们的研究将为 移植项目面临着KT的差异，考虑到他们的情况， 特殊需求和资源。

Project Summary/Abstract Kidney transplantation (KT) is the optimal treatment for end-stage kidney disease (ESKD). It reduces mortality, improves quality of life, and costs less than dialysis. Previous research demonstrated significant disparities in ESKD and its treatment for members of disadvantaged groups [e.g., Hispanic/Latino (HL), American Indians (AI), low income]. Although HL and AI are referred for KT equally with non-Hispanic whites (WH), they are less likely to be wait-listed or to undergo KT than WH. These findings speak to the importance of research focusing on disparities in the evaluation process occurring after referral for KT, rather than on the referral itself. The KT evaluation process is lengthy, time consuming, and burdensome, requiring patients to complete numerous tests to be presented to the transplant team and accepted for KT. Patients must complete testing on their own, which requires them to take charge of a complex series of tests and follow-up visits with specialist providers. Most efforts to reduce disparities in KT emphasize educating or changing the behavior of patients on dialysis who have not been referred for KT. But these approaches do not reduce the burden of the evaluation process on the patient. Further, educating patients does not eliminate external barriers that may prevent patients from completing KT evaluation despite their best intentions to do so. Instead, altering the way care is delivered to patients, by changing the demands of the KT evaluation process on the patient, will significantly reduce KT disparities. The proposed study will assess whether Kidney Transplant Fast Track (KTFT), a streamlined KT evaluation process, or peer navigators (PN) who were former KT patients to help patients “navigate” their way through KT evaluation, can help vulnerable patients with ESKD overcome barriers to transplant listing. After culturally and contextually adapting the two interventions, we will use a comparative effectiveness (CER) approach to conduct a pragmatic randomized trial of 398 ESKD patients to compare the efficacy and effectiveness of the two approaches in disadvantaged groups at a university-affiliated transplant center with large HL and AI ESKD patient populations, and we will compare results to historic comparison populations (local and national). We will assess facilitators and barriers to widespread implementation and conduct a cost effectiveness analysis. Although it is expected that KTFT will be more effective than PN, KTFT may also be more costly, requiring significant administrative and clinical changes in the transplant center, which may be impractical to maintain. Further, KTFT may lead to more patient ambivalence because the shortened evaluation period will give them less time to consider their treatment options. Thus, an important aspect of the proposed study is to comparative the effectiveness of the two methods. Ultimately, our study will inform transplant programs faced with disparities in KT about which disparity-reducing intervention to use given their particular needs and resources.