Increasing Equity in Transplant Evaluation and Living Donor Kidney Transplantation

提高移植评估和活体肾移植的公平性

• 批准号: 8928178
• 负责人: Larissa Myaskovsky
• 金额: $ 50.99万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-18 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8928178
• 关键词: Address; African American; Age; Area; Blood; Cardiac; Caring; Characteristics; Clinical; Discrimination; Education; Effectiveness; End stage renal failure; Ensure; Evaluation; Funding; Healthcare; Healthcare Systems; Hispanics; Income; Intervention; Interview; Kidney; Kidney Transplantation; Knowledge; Latino; Life; Living Donors; Low income; Medical; Minority; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Native Americans; Natural experiment; Outcome; Pamphlets; Pap smear; Participant; Patients; Perception; Process; Provider; Quality of Care; Quality of life; Quasi-experiment; Race; Randomized; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Religion and Spirituality; Reporting; Research; Risk; Site; System; Testing; Time; Transplantation; Variant; Vulnerable Populations; Work; cost effective; cost effectiveness; efficacy testing; experience; follow-up; improved; member; mortality; programs; public health relevance; racism

DESCRIPTION (provided by applicant): Living donor kidney transplantation (LDKT) is the optimal treatment for end-stage kidney disease (ESKD). But, the evaluation process for a kidney transplant is lengthy, time consuming, and burdensome to the patient. Also, race disparities exist in rates of transplant evaluation completion, transplantation, and LDKT. Our previous and ongoing NIDDK-funded research indicates that cultural factors (i.e., perceived discrimination in health care, religious objection to LDKT), transplant knowledge, and demographic characteristics (e.g., age, education, income) independently and significantly predict time to complete transplant evaluation. In December 2012 our transplant center implemented a one-day streamlined evaluation process, dubbed Kidney Transplant Fast Track (KTFT), but it has not been evaluated for efficacy or cost effectiveness. Thus, we propose a quasi-experiment to determine the efficacy and cost-effectiveness of the KTFT (n=1030) compared to historical controls (n=1140) who were recruited for our current NIDDK study to increase transplant rates. At the same time, we will conduct a randomized controlled trial (RCT) targeting vulnerable patients with the educational component of the TALK intervention (Talking About Live Kidney Donation) to increase LDKT. For both components of the application, we will target vulnerable populations because they are most at risk for extended evaluation times and lower rates of LDKT. Using CONSORT standards, participants will be randomly assigned to TALK (n=515) versus no-TALK (n=515) conditions and undergo two interviews at pre-transplant work-up and at completion of transplant evaluation in order to: (1) test whether KTFT and TALK will reduce transplant evaluation time, and increase rates of transplant and LDKT in members of vulnerable groups; (2) determine whether engaging in a streamlined and coordinated-care evaluation experience within the transplant center reduces negative perceptions of the healthcare system; and (3) test the cost effectiveness of the KTFT with TALK relative to standard practices. The results of this two-pronged approach will help pave the way for other transplant centers to implement a Fast Track system at their sites, improve quality of care by transplanting a larger number of vulnerable patients, and may help address stark race/ethnic disparities in rates of LDKT.

描述（由申请人提供）：活体供肾移植（LDKT）是终末期肾病（ESKD）的最佳治疗方法。但是，肾移植的评估过程对患者来说是冗长、耗时和负担的。此外，在移植评估完成率、移植和LDKT方面存在种族差异。我们以前和正在进行的NIDDK资助的研究表明，文化因素（即，医疗保健中的歧视，对LDKT的宗教反对），移植知识，和人口统计学特征（例如，年龄、教育、收入）独立且显著地预测完成移植评估的时间。2012年12月，我们的移植中心实施了为期一天的简化评估流程，称为肾移植快速通道（KTFT），但尚未对其疗效或成本效益进行评估。因此，我们提出了一个准实验，以确定KTFT（n=1030）与历史对照（n=1140）相比的疗效和成本效益，这些对照被招募用于我们目前的NIDDK研究，以提高移植率。与此同时，我们将进行一项随机对照试验（RCT），针对弱势患者进行TALK干预（谈论活体肾脏捐赠）的教育部分，以增加LDKT。对于应用程序的两个组成部分，我们将针对弱势群体，因为他们最有可能延长评估时间和降低LDKT率。使用CONSORT标准，参与者将被随机分配到TALK（n=515）和无TALK（n=515）条件下，并在移植前检查和完成移植评估时进行两次访谈，以便：（1）测试KTFT和TALK是否会减少移植评估时间，并增加弱势群体成员的移植率和LDKT率;（2）确定在移植中心内进行简化和协调的护理评估是否会减少对医疗保健系统的负面看法;（3）测试KTFT与TALK相对于标准实践的成本效益。这种双管齐下的方法的结果将有助于为其他移植中心在其所在地实施快速通道系统铺平道路，通过移植更多的弱势患者来提高护理质量，并可能有助于解决LDKT率的明显种族/民族差异。