Reducing Racial Disparities in Access to Kidney Transplantation: the RaDIANT Regional Study

 描述(由申请人提供)：东南肾移植(SEKTx)联盟是肾脏病学界合作伙伴之间的学术和社区合作，他们的共同目标是消除居住在佐治亚州、北卡罗来纳州和南卡罗来纳州的非裔美国人终末期肾病(ESRD)患者在获得肾脏移植方面的健康差距。这个以社区为基础的联盟的志愿者成员包括ESRD和移植患者、透析设施工作人员和提供者、移植中心、质量改进组织和患者倡导组织。东南部CKD和ESRD的负担最高，但肾移植的发生率却是全国最低的。此外，我们的研究表明，获得移植的种族差异集中在东南部，在那里，非裔美国人(AA)不太可能获得移植过程中的每一步。2014年，我们的SEKTx联盟在美国肾移植比率最低的州GA进行了一项随机、多成分干预(降低获得肾脏移植的差异[辐射])社区研究，包括以患者和提供者为重点的教育和参与干预措施，旨在增加AA ESRD患者的移植评估转诊。这项研究有效地改善了GA中AA之间的肾移植转诊，但改善肾移植机会的努力必须扩大到GA之外，并应包括针对转诊到移植中心医学评估之外的步骤的干预措施。SEKTx联盟的长期目标是消除肾移植过程中每一步的种族差异。我们的具体目标是：具体目标1。确定GA、NC和SC透析患者在肾移植医学评估中存在种族差异的原因。具体目标2：在弗吉尼亚州、北卡罗来纳州和南卡罗来纳州实施辐射区域研究，目标是提高转诊、医疗评估和等候名单的比率，并减少差距 在这些关键步骤中。具体目标3：对辐射区域研究干预措施进行过程和结果评估。这项提议的总体影响是改善东南部AA ESRD人群的移植机会，并减少移植方面的健康差距。

 DESCRIPTION (provided by applicant): The Southeastern Kidney Transplant (SEKTx) Coalition is an academic-community collaboration between partners in the kidney disease community who share the common goal of eliminating health disparities in access to kidney transplantation among African American End Stage Renal Disease (ESRD) living in Georgia, North Carolina, and South Carolina. Volunteer members of this community-based coalition include ESRD and transplant patients, dialysis facility staff and providers, transplant centers, quality improvement organizations, and patient advocacy organizations. The burden of CKD and ESRD is highest in the Southeast, and yet the rate of kidney transplantation is the lowest in the nation. Further, our research suggests that racial disparities in access to transplant are concentrated in the Southeast, where African Americans (AA) are less likely to access each step in the transplant process. In 2014, our SEKTx Coalition conducted a randomized, multicomponent intervention (Reducing Disparities In Access to kidNey Transplantation [RaDIANT]) Community Study in GA, the state with the lowest kidney transplant rates in the nation, consisting of patient- and provider-focused educational and engagement interventions designed to increase referral for transplant evaluation among AA ESRD patients. This study was effective in improving referral for kidney transplantation among AA in GA, but efforts to improve access to kidney transplantation must be expanded beyond GA and should include interventions targeting steps beyond referral to the medical evaluation at the transplant center. The long-term goal of the SEKTx Coalition is to eliminate racial disparities in every step of the kidney transplant process. Our Specific Aims are: Specific Aim 1. Determine reasons for racial disparities in medical evaluation for kidney transplantation among dialysis patients in GA, NC and SC. Specific Aim 2: Implement the RaDIANT Regional Study in GA, NC, and SC with the goal of increasing rates of referral, medical evaluation, and waitlisting, and reducing disparities in these key steps. Specific Aim 3: Conduct a process and outcome evaluation of the RaDIANT Regional Study interventions. The overall impact of this proposal is to improve transplant access among the AA ESRD population in the Southeast and reduce health disparities in transplantation.