Transplant navigator interventuon to overcome barriers to kidney transplantion

与慢性透析治疗相比，肾移植通常提供更长的寿命，更好的治疗效果， 生活质量，并为超过50万患有终末期肾病的美国人降低医疗保健费用。 尽管医疗保险基金几乎所有的肾移植，少数，女性和贫困患者结束 肾病分期减少了肾移植的机会。在之前的工作中，我们确定了 在移植过程中造成了这些差异。其中包括医疗 适合性，对接受移植的兴趣，转诊到移植中心进行移植前检查， 在等候名单上的安排或识别活着的捐赠者，以及从死者或活着的人那里接受肾脏 供体我们现在建议训练移植受者充当移植导航员，然后测试其价值。 使用移植导航器来帮助患者和提供者完成这些步骤。 拟议的基于社区的随机对照试验将涉及100名成年血液透析患者， 干预透析设施和100名患者在3个对照设施比较移植导航 在24个月的时间间隔内进行常规护理干预。基线评价将包括社会人口和 医学特征，移植过程中完成的具体步骤，以及向前推进的障碍 移植过程。导航仪将定期提供量身定制的信息和协助， 患者和他们的肾脏科医生，以帮助他们完成每一步所需的任务。主要成果 将完成移植过程中的额外步骤。次要分析将检查 在移植过程中未能向前推进的受试者中成功干预的障碍 尽管有导航员的帮助 拟议中的项目将测试一种新的干预措施，目标是患者和肾病学家，因为他们在一起 做出与移植相关的决定。未来的工作将涉及确定导航员对 移植率的差异，检查移植导航员的成本效益，并传播 在全国范围内使用。帮助患者完成移植过程中的步骤， 不仅改善了肾移植的可及性， 医疗保健成本和生活质量的提高。

Compared with chronic dialysis treatment, kidney transplantation generally offers a longer life span, a better quality of life, and lower health care costs for the over 500,000 Americans with End Stage Renal Disease. Despite Medicare funding of virtually all kidney transplants, minority, female, and poor patients with End Stage Renal Disease have decreased access to kidney transplantation. In prior work, we identified the steps in the transplant process that are responsible for creating these disparities. These include medical suitability, interest in receiving a transplant, referral to a transplant center for a pre-transplant workup, placement on a waiting list or identification of a living donor, and receipt of a kidney from a deceased or living donor. We now propose to train transplant recipients to act as transplant navigators and then test the value of using transplant navigators to help patients and providers complete these steps. The proposed community-based randomized controlled trial will involve 100 adult hemodialysis patients at 3 intervention dialysis facilities and 100 patients at 3 control facilities to compare a transplant navigator intervention with usual care over a 24 month interval. Baseline evaluation will include sociodemographic and medical characteristics, specific steps completed in the transplant process, and barriers to moving forward in the transplant process. At periodic intervals, the navigator will provide tailored information and assistance to patients and their nephrologists to help them complete the tasks required at each step. The major outcome will be completion of additional steps in the transplant process. Secondary analyses will examine impediments to successful intervention among subjects who fail to move forward in the transplant process despite assistance from a navigator. The proposed project will test a novel intervention that targets patients and nephrologists as they together make transplant-related decisions. Future work will involve determining the impact of navigators on disparities in transplant rates, examining the cost-effectiveness of transplant navigators, and disseminating the intervention for use across the country. Helping patients complete steps in the transplant process may lead not only to improved access to kidney transplantation but also to better patient survival, decreased health care costs, and increased quality of life.