POSTTRANSPLANT QUALITY OF LIFE INTERVENTION STUDY

每年有近12000人选择肾移植作为治疗方法 用于终末期肾病，以努力提高其质量 生活(QOL)。我们先前检查了5种不同的肾脏生活质量结果。 受者，识别预测移植后强化的因素 生活质量。这项调查发现，无论维度如何， 检查、移植后早期发病率、就业和社会支持 预测了QOL的很大一部分差异。因此，我们 建议在我们以前工作的基础上，使用这些QOL预测因子 作为实验性移植后护理计划的基础。这个 这项研究的主要目标将是展示 实验性移植后护理计划影响患者的生活质量 肾移植受者。三套干预措施将强调1) 积极主动的患者主动护理，旨在预防移植 病态，2)保持职业生产力，3) 增强社会支持。研究目标将寻求确定 该实验计划通过降低发病率来改善生活质量， 与标准相比，增加就业，增强社会支持 关心。成本效益也将被确定。 幸运的是，已经有一批患者在接受治疗时 标准的移植护理和完善的所有研究仪器，使 我们使用顺序队列设计，节省了时间和相关的婴儿床 与这次调查有关。将从现有记录中检索数据 对于队列1(对照)。试验计划将落实到位。 并在开始为队列2收集数据之前进行了试点测试 (实验性)。从两个队列中收集的数据将在 移植，一年，两年。成果衡量标准将包括 5生活质量测量，疾病事件的频率，移植后的就业， 和感受到的社会支持。质量调整后的寿命天数将是 成本效益结果。 尽管生活质量经常被认为是选择移植的原因 相对于继续进行维持性透析，目前还没有 旨在测试旨在改善生活质量的干预措施的前瞻性研究 结果。这样的研究在当今时代尤为及时 致力于确保患者获得 最大限度地提高生理和社会心理方面的利益 成本。此外，因为公平的分配政策 器官分布寻求考虑生活质量结果，这很重要 建立以数据为基础的干预措施，以确保所有患者 实现最佳服务质量的平等机会。最后，通过演示一个 改善移植结果的有效方法，我们都将增加 移植器官的寿命和受者的生产力， 从而降低了患者和社会的成本。

Nearly 12,000 people annually choose kidney transplantation as treatment for end-stage renal disease in an effort to improve their quality of life (QoL). We previously examined 5 different QoL outcomes in kidney recipients, identifying factors predictive of enhanced posttransplant QoL. This investigation found that, regardless of the dimension examined, early posttransplant morbidity, employment, and social support predicted a significant portion of the variance in QoL. We therefore propose to build on our previous work and use these predictors of QoL as the basis for an experimental posttransplant program of care. The primary objective of this study will be to demonstrate how an experimental posttransplant care program influences the QoL experienced by kidney recipients. Three sets of interventions will emphasize 1) proactive patient-initiated care designed to prevent transplant morbidities, 2) maintenance of vocational productivity, and 3) enhancement of social support. Research aims will seek to determine if the experimental program improves QoL by decreasing morbidity, increasing employment, and enhancing social support compared to standard care. Cost effectiveness will also be determined. Fortunately, a cohort of patients already exists which as received standard transplant care and completed all study instruments, enabling us to use a sequential cohort design, saving time and cots associated with this investigation. Data will be retrieved from existing records for cohort 1 (control). The experimental program will be put in place and pilot tested prior to beginning data collection for cohort 2 (experimental). Data from both cohorts will be collected at transplantation, one year, and two years. Outcome measures will include 5 QoL measures, frequency of morbid events, posttransplant employment, and perceived social support. Quality adjusted life days will be the cost effectiveness outcome. Although QoL is often cited as the reason for choosing transplantation as opposed to remaining on maintenance dialysis, there has yet to be a prospective study designed to test interventions aimed at improving QoL outcomes. Such a study is particularly timely in the current era of health care where efforts are focused on assuring patients derive maximum benefit, both physiologically and psychosocial, at a minimum cost. In addition, because allocation policies for the equitable distribution of organs seeks to consider QoL outcomes, it is important that data-based interventions be established to assure all patients equal opportunity to achieve optimal QoL. Finally, by demonstrating an effective way to improve transplant outcomes, we will both increase the life of the transplanted organ and the productivity of the recipient, resulting in reduced costs for the patient and society.