CKD awareness and self-management: Interventions for Safety-Net Patients

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DESCRIPTION (provided by applicant): This is a re-submission for a K23 award for Dr. Delphine Tuot, a nephrologist at the University of California, San Francisco. Dr. Tuot is establishing herself as a young investigator in patient-oriented clinical research of chronic kidney disease (CKD). This K23 award will provide Dr. Tuot with the support necessary to accomplish the following goals: (1) to become an expert in the implementation of interventions that improve health outcomes for patients with CKD, in particular those who receive care in a safety-net setting; (2) to implement advanced biostatistical methods in clinical studies; (3) to develop expertise in qualitative research methods and (4) develop an independent clinical research career. To achieve these goals, Dr. Tuot has assembled a mentoring team led by two primary mentors, Dr. Neil Powe, Distinguished Professor, Vice-Chair of Medicine at UCSF and Chief of Medicine at San Francisco General Hospital, whose research program focuses on improving CKD disparities; and Dr. Chi-yuan Hsu, Professor, Chief of Nephrology at UCSF and expert in CKD outcomes research. Her larger mentoring team also includes Dr. Margaret Handley, a nationally recognized leader in the field of implementation research in vulnerable populations and Dr. Charles McCulloch, Head of the Division of Biostatistics at UCSF and expert in longitudinal analyses for repeated measures. Dr. Daniel Dohan, who has expertise in qualitative research methods with a focus on chronic disease, will serve as a very close collaborator. CKD is common in the U.S. adult population and is associated with excess mortality and morbidity. There has been poor adoption of evidence-based therapies (medical and behavioral) that improve health outcomes among CKD patients. The lack of translation may be in part due to low patient awareness of CKD, which may disproportionately affect safety-net populations. Dr. Tuot's research will examine the impact of CKD awareness on patient behaviors and health outcomes (Aim 1) and investigate whether an evidence-based CKD-specific self-management program using novel telephone technology, impacts CKD progression through increased patient self-efficacy regarding CKD and greater engagement in risk-reduction behaviors (Aim 2). Additionally, she will identify safety-net patients' perceived role in disease management and their unmet needs to engage in behaviors that slow CKD progression. Results of both her quantitative and qualitative studies will refine the telephone intervention in Aim 2 an inform the development and administration of a new text-based self-management support program for safety-net patients with CKD who may not engage with telephone interventions (Aim 3). This research will form the basis for a multi-center clinical trial assessing the efficacy and effectiveness of various self-management programs on health outcomes among diverse patients with CKD, to be proposed in an R01 grant application before the end of the K award period. PUBLIC HEALTH RELEVANCE: Chronic kidney disease affects up to 13% of the United States adult population and leads to excess mortality and morbidity. Delivery of effective management for CKD is limited because few CKD patients are aware of their disease, which is largely clinically silent. In this study, we plan to explore the implications of patient awareness of CKD o health outcomes, examine the impact of an existing CKD self-management program on behavior change and identify safety-net patients' unmet needs to engage in risk-reduction behaviors. In turn, these data will be used to refine an existing telephone self-management program and inform the development and administration of a text-based CKD self-management support intervention, both designed to improve health outcomes among safety-net patients with CKD.