Access to Kidney Transplantation in Minority Populations (AKT-MP)

项目摘要/摘要 肾移植(KT)是终末期肾病(ESKD)的最佳治疗方法。它降低了死亡率， 改善生活质量，而且比透析费用更低。先前的研究表明，在 ESKD及其对弱势群体成员的待遇[例如，西班牙裔/拉丁裔(HL)，美国印第安人 (AI)，低收入]。虽然HL和AI与非西班牙裔白人(WH)一样被称为KT，但他们的比例较低 可能会被列入轮候名单或接受KT而不是WH。这些发现说明了集中研究的重要性。 关于KT转介后评价过程中出现的差异，而不是转介本身。KT 评估过程漫长、耗时、负担重，需要患者完成许多 提交给移植团队并接受KT的测试。患者必须自己完成检测， 这需要他们负责一系列复杂的测试和与专家提供者的后续访问。 减少KT差异的大多数努力都强调教育或改变透析患者的行为 他们还没有被转介到KT。但这些方法并不能减轻评估过程的负担。 在病人身上。此外，教育患者并不能消除可能阻止患者 完成KT评估，尽管他们有这样做的良好意图。相反，改变医疗服务的交付方式 患者通过改变患者对KT评估过程的要求，将显著降低KT 差距。拟议的研究将评估肾移植快速通道(KTFT)，一种简化的KT 评估流程，或前KT患者的同行导航员(PN)，帮助患者“导航”他们的方式 通过KT评估，可以帮助易患ESKD的患者克服移植上市的障碍。之后 从文化和背景上适应这两种干预措施，我们将使用比较有效性(CER) 对398例ESKD患者进行实用型随机试验的方法比较 两种方法在大学附属移植中心弱势群体中的有效性 大的HL和AI ESKD患者群体，我们将把结果与历史上的比较人群进行比较 (地方和国家)。我们将评估广泛实施的促进者和障碍，并进行成本评估 有效性分析。尽管预计KTFT将比PN更有效，但KTFT也可能 成本更高，需要对移植中心进行重大的管理和临床改革，这可能是 维护起来不切实际。此外，KTFT可能会导致更多的耐心矛盾心理，因为缩短的 评估期将给他们更少的时间来考虑他们的治疗方案。因此，一个重要的方面是 提出的研究是对两种方法的有效性进行比较。最终，我们的研究将告诉我们 移植计划面临着KT中的差异，关于使用哪种减少差异的干预措施 特殊的需求和资源。

Project Summary/Abstract Kidney transplantation (KT) is the optimal treatment for end-stage kidney disease (ESKD). It reduces mortality, improves quality of life, and costs less than dialysis. Previous research demonstrated significant disparities in ESKD and its treatment for members of disadvantaged groups [e.g., Hispanic/Latino (HL), American Indians (AI), low income]. Although HL and AI are referred for KT equally with non-Hispanic whites (WH), they are less likely to be wait-listed or to undergo KT than WH. These findings speak to the importance of research focusing on disparities in the evaluation process occurring after referral for KT, rather than on the referral itself. The KT evaluation process is lengthy, time consuming, and burdensome, requiring patients to complete numerous tests to be presented to the transplant team and accepted for KT. Patients must complete testing on their own, which requires them to take charge of a complex series of tests and follow-up visits with specialist providers. Most efforts to reduce disparities in KT emphasize educating or changing the behavior of patients on dialysis who have not been referred for KT. But these approaches do not reduce the burden of the evaluation process on the patient. Further, educating patients does not eliminate external barriers that may prevent patients from completing KT evaluation despite their best intentions to do so. Instead, altering the way care is delivered to patients, by changing the demands of the KT evaluation process on the patient, will significantly reduce KT disparities. The proposed study will assess whether Kidney Transplant Fast Track (KTFT), a streamlined KT evaluation process, or peer navigators (PN) who were former KT patients to help patients “navigate” their way through KT evaluation, can help vulnerable patients with ESKD overcome barriers to transplant listing. After culturally and contextually adapting the two interventions, we will use a comparative effectiveness (CER) approach to conduct a pragmatic randomized trial of 398 ESKD patients to compare the efficacy and effectiveness of the two approaches in disadvantaged groups at a university-affiliated transplant center with large HL and AI ESKD patient populations, and we will compare results to historic comparison populations (local and national). We will assess facilitators and barriers to widespread implementation and conduct a cost effectiveness analysis. Although it is expected that KTFT will be more effective than PN, KTFT may also be more costly, requiring significant administrative and clinical changes in the transplant center, which may be impractical to maintain. Further, KTFT may lead to more patient ambivalence because the shortened evaluation period will give them less time to consider their treatment options. Thus, an important aspect of the proposed study is to comparative the effectiveness of the two methods. Ultimately, our study will inform transplant programs faced with disparities in KT about which disparity-reducing intervention to use given their particular needs and resources.