POSTTRANSPLANT QUALITY OF LIFE INTERVENTION STUDY

每年有近12，000人选择肾移植作为治疗 为终末期肾病，努力提高他们的质量， 生活质量（QoL）。 我们之前检查了5种不同的肾脏QoL结局 受体，确定移植后增强的预测因素 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的显著差异。 因此我们 我建议建立在我们以前的工作，并使用这些预测生活质量 作为实验性移植后护理计划的基础。 的 本研究的主要目的是证明 实验性移植后护理计划影响生活质量 肾脏移植者。 三套干预措施将强调1） 预防移植的患者主动护理 发病率，2）维持职业生产力，以及3） 加强社会支持。 研究目的是确定是否 该实验方案通过降低发病率来改善QoL， 与标准相比，增加就业和加强社会支持 在乎 还将确定成本效益。 幸运的是，已经有一组患者， 标准移植护理并完成所有研究工具， 我们使用序贯队列设计，节省时间和相关的婴儿床 参与这次调查 将从现有记录中检索数据 对于组群1（对照）。实验方案将落实到位 并在开始队列2的数据收集之前进行初步测试 （实验性）。两个队列的数据将在 移植，一年，两年。 结果指标将包括 5生活质量指标，病态事件的频率，移植后就业， 和感知到的社会支持 质量调整生活日将是 成本效益的结果。 虽然生活质量通常被认为是选择移植的原因， 与维持性透析相反， 旨在测试旨在改善QoL的干预措施的前瞻性研究 结果。 这样的研究在当今时代特别及时， 医疗保健，努力集中在确保患者获得 最大限度地从生理和心理社会两方面获益， 成本 此外，由于公平分配政策 器官分布寻求考虑QoL结果，这很重要 建立基于数据的干预措施，以确保所有患者 平等机会实现最佳QoL。 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体的生产力， 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.