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

CKD 意识和自我管理：安全网患者的干预措施

• 批准号: 8442811
• 负责人: Delphine Tuot
• 金额: $ 18.84万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-20 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8442811
• 关键词: Adoption; Adult; Affect; Anti-Inflammatory Agents; Anti-inflammatory; Applications Grants; Arthritis; Awareness; Behavior; Behavioral; Biometry; Biostatistical Methods; California; Car Phone; Caring; Cessation of life; Chronic Disease; Chronic Kidney Failure; Clinical; Clinical Research; Communities; Counseling; Data; Data Collection; Development; Diabetes Mellitus; Disease; Disease Management; Disease Outcome; Disease Progression; Education; Effectiveness; End stage renal failure; Excess Mortality; Funding; Future; General Hospitals; Goals; Head; Health; Health behavior change; Health behavior outcomes; Hospitalization; Hypertension; Individual; Intervention; Interview; K-Series Research Career Programs; Kidney; Kidney Diseases; Life; Life Style; Link; Measures; Mediating; Medical; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Morbidity - disease rate; Multi-Institutional Clinical Trial; National Institute of Diabetes and Digestive and Kidney Diseases; Nephrology; Obesity; Outcome; Outcomes Research; Participant; Patients; Pharmaceutical Preparations; Physical activity; Pilot Projects; Population; Prevalence; Qualitative Research; Random Allocation; Randomized Controlled Trials; Registries; Research; Research Methodology; Research Personnel; Risk; Risk Reduction Behavior; Role; Safety; San Francisco; Self Efficacy; Self Management; Structure; System; Technology; Telephone; Testing; Text; Time; Tobacco; Tobacco use; Training; Translations; United States; United States National Institutes of Health; Universities; Ursidae Family; Vulnerable Populations; base; behavior change; behavior measurement; blood pressure regulation; burden of illness; career; career development; cohort; design; ethnic minority population; evidence base; experience; follow-up; implementation research; improved; innovation; kidney disease education; low socioeconomic status; novel; patient oriented; preference; professor; programs; prospective; safety net; treatment as usual

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.

描述（由申请人提供）：这是Delphine Tuot博士的K23奖的重新提交，她是加州大学旧金山分校的肾病学家。Tuot博士是一名以患者为导向的慢性肾脏疾病（CKD）临床研究的年轻研究者。K23奖将为Tuot博士提供必要的支持，以实现以下目标：(1)成为实施干预措施的专家，改善CKD患者的健康结果，特别是那些在安全网环境中接受治疗的患者；(2)在临床研究中应用先进的生物统计学方法；(3)发展定性研究方法方面的专业知识；(4)发展独立的临床研究事业。为了实现这些目标，Tuot博士组建了一个由两位主要导师领导的指导团队：杰出教授、加州大学旧金山分校医学副主席、旧金山总医院医学主任Neil Powe博士，他的研究项目侧重于改善CKD差异；以及加州大学旧金山分校肾内科主任、CKD预后研究专家徐志远教授。她更大的指导团队还包括玛格丽特·汉德利博士（Margaret Handley）和查尔斯·麦卡洛克博士（Charles McCulloch），后者是全国公认的弱势群体实施研究领域的领导者，他是加州大学旧金山分校生物统计学系主任，也是重复测量的纵向分析专家。Daniel Dohan博士在专注于慢性病的定性研究方法方面具有专长，他将作为非常密切的合作者。慢性肾病在美国成年人中很常见，并且与过高的死亡率和发病率有关。在CKD患者中，改善健康结果的循证疗法（医学和行为）的采用很少。缺乏翻译的部分原因可能是由于患者对CKD的认识较低，这可能不成比例地影响安全网人口。Tuot博士的研究将检查CKD意识对患者行为和健康结果的影响（目标1），并调查基于证据的CKD特定自我管理计划是否使用新型电话技术，通过提高患者对CKD的自我效能感和更多地参与降低风险的行为来影响CKD进展（目标2）。此外，她将确定安全网患者在疾病管理中的感知作用，以及他们未满足的参与减缓CKD进展的行为的需求。她的定量和定性研究的结果将完善目标2中的电话干预，并为可能不参与电话干预的CKD患者的安全网提供新的基于文本的自我管理支持计划的开发和管理（目标3）。本研究将成为多中心临床试验评估疗效的基础