Multi-level Factors that Influence Dialysis Facilities' Assessments of Patient Suitability for Transplantation

影响透析机构评估患者移植适宜性的多层次因素

• 批准号: 10191572
• 负责人: Adam Steven Wilk
• 金额: $ 15.25万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10191572
• 关键词: Address; Administrator; Advocate; Affect; Anxiety; Area; Assessment tool; Caring; Characteristics; Clinical; Communities; Complex; Consolidated Framework for Implementation Research; Cross-Sectional Studies; Data; Data Collection; Data Set; Decision Aid; Development; Dialysis procedure; End stage renal failure; Evaluation; Fostering; Future; Goals; Grant; Health Services; Incidence; Income; Individual; Intervention; Interview; Investigation; Joints; Judgment; K-Series Research Career Programs; Kidney Diseases; Kidney Transplantation; Knowledge; Lead; Link; Low income; Measurable; Measures; Medical; Mentored Research Scientist Development Award; Mentors; Mentorship; Minor; National Institute of Diabetes and Digestive and Kidney Diseases; Nephrology; Obesity; Outcome; Patient-Focused Outcomes; Patients; Policies; Population; Process; Process Assessment; Protocols documentation; Provider; Psychosocial Assessment and Care; Public Health Schools; Qualitative Methods; Quality of life; Reporting; Research; Research Methodology; Research Personnel; Resources; Shapes; Standardization; Stress; Structure; Suggestion; Surveys; Team Process; Testing; Time; Training; Transplant Recipients; Transplantation; Treatment outcome; Uncertainty; Universities; Validation; Waiting Lists; Weighing patient; Wrestling; Writing; black patient; care providers; career; cognitive load; complex chronic conditions; contextual factors; design; disease diagnosis; ethnic minority population; experience; health disparity; implementation framework; improved; interest; optimal treatments; peer; pressure; professor; provider factors; racial and ethnic; racial and ethnic disparities; relative cost; response; skills; socioeconomic disparity; theories; tool; training opportunity; transplant centers

Project Summary/Abstract For most patients with end-stage renal disease (ESRD), kidney transplantation is the optimal treatment. Underserved racial/ethnic minority and low-income individuals have a greater burden of ESRD (higher incidence and more rapid progression), yet they have much poorer access to transplant. Before patients are considered for waitlisting at a transplant center, dialysis facility teams perform complex medical and psychosocial assessments of patients' suitability for transplant and decide whether to refer them to a transplant center for full evaluation. These pre-referral assessment processes, which vary widely across clinical teams, have been identified as among the most important potential drivers of downstream disparities in transplant waitlisting and receipt. The objective of this application for a NIDDK Mentored Research Scientist Development Award (K01) is to support an assistant professor at the Emory University Rollins School of Public Health to become an independent health services researcher fully equipped with the skills to build understanding of these patient assessment processes and to improve their treatment outcomes. To that end, this K01 award will provide training in clinical nephrology, qualitative and survey research methods, implementation science frameworks, and grant-writing. The research aims are designed to reinforce and apply these new skills and concepts in an investigation of dialysis facilities' pre-referral patient assessment processes. Specifically, the K01's research objective is to use rigorous qualitative and survey research methods to elucidate the measurable and modifiable provider-level constructs of cognitive load (stress, time pressure, disruptions) and uncertainty tolerance (anxiety or worry in response to uncertainty) and their impact on disparities in pre-referral assessments within their dialysis facility context. Aim 1 will use qualitative methods to explore how provider- level factors (e.g., cognitive load, uncertainty tolerance) and multi-level contextual factors (e.g., facility-level standard protocols, local transplant center policies) shape dialysis facility teams' processes for pre-referral patient assessment. Aim 2 will develop and validate a survey to quantify staff, dialysis facility, and community characteristics in the context of pre-referral assessments using a survey pilot and a rigorous modified Delphi approach. Aim 3 will conduct a survey of n≈2000 dialysis facility staff across 13 states and use linked data on patient transplant evaluation outcomes (referral, evaluation start, and waitlisting) to assess how staff cognitive load and uncertainty tolerance are related to racial/ethnic and socioeconomic disparities in transplant access as well as dialysis facility and community characteristics. The protected time, resources, and mentoring available through this career development award will enable Dr. Adam Wilk to emerge as an independent and leading researcher, conducting groundbreaking survey research and fostering the development and implementation of multi-level interventions to address barriers in access to transplant or other preferred treatments for underserved patients with kidney disease and other complex chronic conditions.

项目摘要/摘要 对于大多数终末期肾脏疾病（ESRD）的患者，肾脏移植是最佳治疗方法。 服务不足的种族/族裔少数民族和低收入个人的ESRD燃烧更大（更高 发病率和更快的进展），但是他们获得移植的机会较差。在患者之前 考虑在移植中心等待列表，透析设施团队执行复杂的医疗和 患者对移植的适用性的社会心理评估，并决定是否将其转介给移植 全面评估中心。这些转屈的评估过程在临床团队中差异很大， 已被确定为移植中下游分布的最重要的驱动因素之一 等待列表和收据。 NIDDK指导研究科学家发展的申请的目的 奖项（K01）将支持埃默里大学罗林斯公共卫生学院的助理教授 成为一名独立的卫生服务研究人员，完全配备了建立对理解的技能 这些患者评估过程并改善其治疗结果。为此，该K01奖将 提供临床肾脏病，定性和调查研究方法，实施科学培训 框架和赠款写作。研究目的旨在增强和运用这些新技能和 透析设施的投资预期患者评估过程中的概念。具体来说， K01的研究目标是使用严格的定性和调查研究方法来阐明 可测量且可修改的提供商级别的认知负载（压力，时间压力，干扰）和 不确定性耐受性（对不确定性的焦虑或担心）及其对转诊前差异的影响 在其透析设施环境中的评估。 AIM 1将使用定性方法来探索提供商如何 级别因素（例如，认知载荷，不确定性耐受性）和多级上下文因素（例如，设施级别 标准协议，本地移植中心政策）形状透析设施团队的行政程序的流程 患者评估。 AIM 2将开发和验证一项调查，以量化员工，透析设施和社区 使用调查飞行员和严格的修改后的Delphi进行转诊前评估的特征 方法。 AIM 3将对13个州的N≈2000个透析设施人员进行调查，并使用有关的链接数据 患者移植评估结果（推荐，评估开始和候补名单），以评估员工认知如何 负载和不确定性耐受性与移植访问中的种族/种族和社会经济差异有关 以及透析设施和社区特征。受保护的时间，资源和心理 通过此职业发展奖获得，将使Adam Wilk博士能够成为独立和 领先的研究人员，进行开创性的调查研究并促进发展和 实施多层干预措施，以解决访问移植或其他首选的障碍 服务不足的肾脏疾病和其他复杂慢性病患者的治疗。