CKD awareness and self-management: Interventions for Safety-Net Patients

描述（由申请人提供）：这是弗朗西斯科加州大学肾脏病学家Delphine Tuot博士重新提交的K23奖。Tuot博士是一名年轻的研究者，从事以患者为导向的慢性肾脏病（CKD）临床研究。该K23奖项将为Tuot博士提供必要的支持，以实现以下目标：（1）成为实施干预措施的专家，改善CKD患者的健康结果，特别是那些在安全网环境中接受治疗的患者;（2）在临床研究中实施先进的生物统计方法;（3）发展定性研究方法的专业知识和（4）发展独立的临床研究生涯。为了实现这些目标，Tuot博士组建了一个由两名主要导师领导的指导团队，一位是UCSF医学副主席兼San弗朗西斯科总医院医学主任、杰出教授Neil Yu博士，他的研究项目专注于改善CKD差异;另一位是UCSF肾脏病学主任、CKD结局研究专家许致远博士。她的更大的指导团队还包括玛格丽特汉德利博士，在弱势群体的实施研究领域的国家公认的领导者和查尔斯麦卡洛克博士，生物统计学在加州大学旧金山分校的部门负责人和专家在重复测量的纵向分析。丹尼尔多汉博士，谁在定性研究方法的专业知识，重点是慢性病，将作为一个非常密切的合作者。 CKD在美国成年人群中很常见，与死亡率和发病率过高有关。改善CKD患者健康结局的循证疗法（医学和行为）的采用率很低。缺乏翻译可能部分是由于患者对CKD的认识较低，这可能不成比例地影响安全网人群。Tuot博士的研究将检查CKD意识对患者行为和健康结果的影响（目标1），并调查使用新型电话技术的循证CKD特异性自我管理计划是否通过增加患者对CKD的自我效能和更多地参与降低风险行为来影响CKD进展（目标2）。此外，她将确定安全网患者在疾病管理中的感知作用以及他们未满足的需求，以参与减缓CKD进展的行为。她的定量和定性研究的结果将完善目标2中的电话干预，并为可能不接受电话干预的CKD安全网患者（目标3）制定和实施新的基于文本的自我管理支持计划提供信息。这项研究将为评估疗效的多中心临床试验奠定基础 以及各种自我管理计划对不同CKD患者健康结果的有效性，将在K奖结束前在R 01补助金申请中提出。

DESCRIPTION (provided by applicant): This is a re-submission for a K23 award for Dr. Delphine Tuot, a nephrologist at the University of California, San Francisco. Dr. Tuot is establishing herself as a young investigator in patient-oriented clinical research of chronic kidney disease (CKD). This K23 award will provide Dr. Tuot with the support necessary to accomplish the following goals: (1) to become an expert in the implementation of interventions that improve health outcomes for patients with CKD, in particular those who receive care in a safety-net setting; (2) to implement advanced biostatistical methods in clinical studies; (3) to develop expertise in qualitative research methods and (4) develop an independent clinical research career. To achieve these goals, Dr. Tuot has assembled a mentoring team led by two primary mentors, Dr. Neil Powe, Distinguished Professor, Vice-Chair of Medicine at UCSF and Chief of Medicine at San Francisco General Hospital, whose research program focuses on improving CKD disparities; and Dr. Chi-yuan Hsu, Professor, Chief of Nephrology at UCSF and expert in CKD outcomes research. Her larger mentoring team also includes Dr. Margaret Handley, a nationally recognized leader in the field of implementation research in vulnerable populations and Dr. Charles McCulloch, Head of the Division of Biostatistics at UCSF and expert in longitudinal analyses for repeated measures. Dr. Daniel Dohan, who has expertise in qualitative research methods with a focus on chronic disease, will serve as a very close collaborator. CKD is common in the U.S. adult population and is associated with excess mortality and morbidity. There has been poor adoption of evidence-based therapies (medical and behavioral) that improve health outcomes among CKD patients. The lack of translation may be in part due to low patient awareness of CKD, which may disproportionately affect safety-net populations. Dr. Tuot's research will examine the impact of CKD awareness on patient behaviors and health outcomes (Aim 1) and investigate whether an evidence-based CKD-specific self-management program using novel telephone technology, impacts CKD progression through increased patient self-efficacy regarding CKD and greater engagement in risk-reduction behaviors (Aim 2). Additionally, she will identify safety-net patients' perceived role in disease management and their unmet needs to engage in behaviors that slow CKD progression. Results of both her quantitative and qualitative studies will refine the telephone intervention in Aim 2 an inform the development and administration of a new text-based self-management support program for safety-net patients with CKD who may not engage with telephone interventions (Aim 3). This research will form the basis for a multi-center clinical trial assessing the efficacy and effectiveness of various self-management programs on health outcomes among diverse patients with CKD, to be proposed in an R01 grant application before the end of the K award period.