Telemedicine for Evaluation and Counseling of Living Kidney Donor Candidates

用于活体肾脏捐赠者候选者评估和咨询的远程医疗

基本信息

批准号：
10634616
负责人：
Fawaz Al Ammary
金额：
$ 19.71万
依托单位：
UNIVERSITY OF CALIFORNIA-IRVINE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-15 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10634616
关键词：
Adoption Ambulatory Care Facilities Award Caring Client satisfaction Clinic Visits Clinical Trials Design Collection Complex Consensus Counseling Data Eligibility Determination Enrollment Ensure Ethnic Origin Evaluation Expert Opinion Feedback Focus Groups Funding Future Geography Goals Image Improve Access Intervention Intervention Trial Interview Kidney Kidney Failure Kidney Transplantation Knowledge Laboratories Living Donors Logistics Medical Medical History Methods Nephrectomy Outcome Participant Patients Perception Persons Phase Primary Care Process Protocols documentation Published Comment Qualitative Research Questionnaires Race Reporting Research Research Methodology Sampling Screening Result Structure Surveys Telemedicine Time Translating Visit Work care coordination design digital intervention effectiveness testing experience improved innovation living kidney donor multidisciplinary pandemic disease pilot test preference process improvement programs randomized, clinical trials satisfaction screening skills social transplant centers video visit

项目摘要

PROJECT SUMMARY Nearly 100,000 patients with kidney failure in the US await kidney transplantation. Living donation reduces the wait and offers superior survival compared with deceased donation. Yet only 6,000 living kidney donations are achieved every year with a substantial decline in donation among biologically related donors in across race/ethnicity. While prior programs were associated with a 6-fold increase in donor referral, efforts to convert donor candidates to donor nephrectomy have been largely unsuccessful. Access to a transplant center is a key barrier to engagement of donor candidates. Alas, the pandemic has amplified this existing barrier. Living kidney donor evaluation is a complex multiphase process that includes activities over approximately one year. We have previously reported that two-thirds of referred persons are deemed medically ineligible donors after reviewing medical history and/or laboratory screening results. Of the one-third who are deemed eligible donor candidates, only 54% complete donor evaluation and counseling (of whom 58% ultimately donate), whereas 35% cannot proceed to complete this initial outpatient clinic visit due to non-medical (personal, social, and arrangement) reasons. The initial outpatient clinic visit is thus a bottleneck as it involves the first obligatory trip to an in-person visit where access to a transplant center becomes a barrier for willing candidates facing geographic, financial, or logistics challenges to come for their initial in-person evaluations. Efforts to promote engagement of kidney donor candidates are needed. Telemedicine via synchronous video visits can facilitate coordination of care in the donor evaluation process. Donor evaluation may become more accessible, efficient, and convenient. The rapid adoption of telemedicine during the pandemic has created opportunities and challenges. In our national survey of US transplant centers, we found that 81% reported telemedicine challenges related to structure and processes of care. In primary care studies, telemedicine video visits have achieved high levels of patient satisfaction and similar outcomes compared to in-person visits. A knowledge gap exists regarding how donor candidates perceive telemedicine in care coordination, and how to best tailor telemedicine care coordination in donor evaluation. Our scientifically goal is to integrate a telemedicine care coordination intervention into the donor evaluation process to enhance engagement of donor candidates and support completion of their evaluation. This award will allow Dr. Al Ammary the protected time to complete his proposed research. Findings of this work will fill a knowledge gap about the new paradigm using telemedicine for donor evaluation and offer preliminary data for an R01-funded randomized clinical trial to test the effectiveness of telemedicine care coordination in increasing living donation and support his transition to independence.

项目摘要在美国，近100,000名肾衰竭患者正在等待肾脏移植。生活捐赠减少了与已故捐赠相比，等待并提供了卓越的生存。然而，只有6,000个活肾脏捐赠每年都能实现，整个生物学相关捐赠者的捐赠大幅下降种族/种族。虽然先前的计划与捐助者转介增加了6倍，但努力转换供体肾切除术的供体候选者在很大程度上没有成功。进入移植中心是关键参与捐助者候选人的障碍。 las，大流行已经放大了现有的障碍。活肾脏捐赠者评估是一个复杂的多相过程，包括大约一个活动的活动年。我们以前曾报道说，三分之二的推荐人被认为是医学上不合格的捐助者在审查了病史和/或实验室筛查结果之后。被认为有资格的三分之一捐助者候选人，只有54％的捐助者评估和咨询（其中58％最终捐款），而35％的人由于非医学，个人，社会，和安排）原因。因此，最初的门诊诊所就诊是一种瓶颈，因为它涉及第一个强制性前往面对面的访问，进入移植中心成为愿意面对的候选人的障碍对于他们的初步面对面评估，地理，财务或物流挑战。促进的努力需要肾脏捐赠者候选人的参与。通过同步视频访问远程医疗可以促进捐助者评估过程中的护理协调。捐助者评估可能会变得更容易获得，高效，方便。大流行期间远程医疗的迅速采用创造了机会和挑战。在我们对美国移植中心的全国调查中，我们发现有81％的人报告了远程医疗与护理结构和过程有关的挑战。在初级保健研究中，远程医疗视频访问有与面对面访问相比，获得了高水平的患者满意度和相似的结果。知识关于供体候选人如何看待远程医疗的护理协调以及如何最佳裁缝的存在差距供体评估中的远程医疗护理协调。我们的科学目标是将远程医疗护理协调干预融合到捐助者评估中加强捐助者参与并支持完成评估的过程。这个奖项将允许Al Ammary博士受保护的时间完成他的拟议研究。这项工作的发现将填补使用远程医疗评估远程医疗对新范式的知识差距，并提供初步数据 R01资助的随机临床试验，以测试远程医疗协调在增加的有效性生活捐赠并支持他向独立过渡。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Patient and Graft Survival After A1/A2-incompatible Living Donor Kidney Transplantation.

DOI：
10.1097/txd.0000000000001388
发表时间：
2022-11
期刊：
Transplantation direct
影响因子：
2.3
作者：
通讯作者：

Living kidney donors with HIV: experience and outcomes from a case series by the HOPE in Action Consortium.

DOI：
10.1016/j.lana.2023.100553
发表时间：
2023-08
期刊：
LANCET REGIONAL HEALTH-AMERICAS
影响因子：
0
作者：
Durand, Christine M.;Martinez, Nina;Neumann, Karl;Benedict, Reed C.;Baker, Arthur W.;Wolfe, Cameron R.;Stosor, Valentina;Shetty, Aneesha;Dietch, Zachary C.;Goudy, Leah;Callegari, Michelle A.;Massie, Allan B.;Brown, Diane;Cochran, Willa;Muzaale, Abimereki;Fine, Derek;Tobian, Aaron A. R.;Winkler, Cheryl A.;Al Ammary, Fawaz;Segev, Dorry L.
通讯作者：
Segev, Dorry L.

Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: A systematic review.

DOI：
10.1111/ajt.17017
发表时间：
2022-07
期刊：
AMERICAN JOURNAL OF TRANSPLANTATION
影响因子：
8.8
作者：
Alvarado, Flor;Cervantes, Carmen Elena;Crews, Deidra C.;Blanck, Jamie;Al Ammary, Fawaz;Ng, Derek K.;Purnell, Tanjala S.
通讯作者：
Purnell, Tanjala S.

The Scope of Telemedicine in Kidney Transplantation: Access and Outreach Services.

DOI：
10.1053/j.ackd.2021.10.003
发表时间：
2021-11
期刊：
Advances in chronic kidney disease
影响因子：
2.9
作者：
Al Ammary F;Concepcion BP;Yadav A
通讯作者：
Yadav A

External Validation of Toulouse-Rangueil eGFR12 Prediction Model After Living Donor Nephrectomy.

DOI：
10.3389/ti.2023.11619
发表时间：
2023
期刊：
TRANSPLANT INTERNATIONAL
影响因子：
3.1
作者：
Patel, Suhani S.;Lonze, Bonnie E.;Chiang, Teresa Po-Yu;Al Ammary, Fawaz;Segev, Dorry L.;Massie, Allan B.
通讯作者：
Massie, Allan B.