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

• 批准号: 10763135
• 负责人: Fawaz Al Ammary
• 金额: $ 11.72万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 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/10763135
• 关键词: Telemedicine; Evaluation; Counseling; Living; Kidney

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.

项目总结 美国有近10万名肾衰竭患者在等待肾移植。活体捐赠减少了 等待，与已故的捐赠相比，提供更好的存活率。然而，只有6000个活体肾脏捐赠是 随着世界各地与生物相关的捐赠者的捐赠量大幅下降，每年都能实现这一目标 种族/民族。虽然以前的方案与捐助者转介增加了6倍有关，但努力将 供肾切除手术的供者候选人大多未获成功。进入移植中心是关键 阻碍捐助者候选人参与的障碍。唉，这场大流行放大了这一现有障碍。 活体肾脏捐赠者的评估是一个复杂的多阶段过程，包括大约一个以上的活动。 年。我们以前报告过，三分之二的被转介的人被认为是不符合医疗条件的捐赠者 在回顾病史和/或实验室筛查结果之后。在三分之一的被认为符合资格的人中 捐赠者候选人，只有54%完成捐赠者评估和咨询(其中58%最终捐赠)， 而35%的人由于非医疗(个人、社交、 和安排)原因。因此，最初的门诊就诊是一个瓶颈，因为它涉及第一个强制性的 亲身访问移植中心成为有意愿的候选人面临的障碍 他们将面临地理、财务或物流方面的挑战，进行最初的面对面评估。努力促进 肾脏捐赠者候选人的参与是必要的。通过同步视频访问的远程医疗可以促进 在捐助者评价过程中协调护理工作。捐助者评估可能会变得更容易获得、更有效、 而且很方便。在大流行期间迅速采用远程医疗创造了机会和 挑战。在我们对美国移植中心的全国调查中，我们发现81%的人报告了远程医疗 与护理结构和流程有关的挑战。在初级保健研究中，远程医疗视频访问 与面对面访问相比，获得了高水平的患者满意度和类似的结果。一种知识 关于捐赠者候选人如何看待远程医疗在护理协调方面的看法，以及如何最好地定制，存在着差距 在捐赠者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整合到捐赠者评估中 加强捐助者候选人参与的进程，并支持完成他们的评价。本奖项 将让阿尔·阿莫里博士有足够的时间来完成他提议的研究。这项工作的发现将填补 关于使用远程医疗进行捐赠者评估的新范式的知识差距，并为 一项由R01资助的随机临床试验，以测试远程医疗护理协调在增加 活体捐赠并支持他向独立的过渡。