Advance Care Coordination and Enhanced Linkage and Retention Among Transitional Re-Entrants Living

过渡性重新入境者生活中的预先护理协调以及加强联系和保留

• 批准号: 10369660
• 负责人: Matthew Akiyama
• 金额: $ 24.9万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10369660
• 关键词: Achievement; Address; Admission activity; Aftercare; Antiviral Agents; Applications Grants; Appointment; Appointments and Schedules; Award; Behavior Therapy; Caring; Cause of Death; Cirrhosis; Clinical Investigator; Communities; Counseling; Criminal Justice; Data; Development; Discharge Plannings; Drug usage; Education; Effectiveness; Effectiveness of Interventions; Elements; Ensure; Epidemic; Foundations; Funding; Future; Goals; HIV; Health; Health Personnel; Health Transition; Healthcare; Healthcare Systems; Hepatitis C; Hepatitis C Prevalence; Hepatitis C Therapy; Hepatitis C Transmission; Hepatitis C virus; Hospitalization; Imprisonment; Individual; Intervention; Interview; Jail; Knowledge; Lead; Length of Stay; Link; Logistics; Measures; Medical; Mentors; Mentorship; Morbidity - disease rate; Motivation; Needs Assessment; New York City; Outcome; Patients; Phase; Population; Prevalence; Primary carcinoma of the liver cells; Prisons; Process Measure; Prospective Studies; Provider; Public Health; Randomized; Randomized Controlled Trials; Research; Research Methodology; Research Personnel; Risk Behaviors; Site; Social support; Statistical Data Interpretation; Structure; Substance Use Disorder; System; Telephone; Testing; Time; Training; Treatment outcome; United States; Visit; arm; barrier to care; base; care coordination; career; career development; community transmission; design; effectiveness testing; efficacy testing; experience; feasibility testing; health care service utilization; health knowledge; high risk; improved; innovation; longitudinal analysis; mortality; peer; peer coaching; pilot test; pilot trial; programs; public health intervention; randomized trial; research and development; response; side effect; skills; social cognitive theory; standard of care

ABSTRACT The overarching goal of this research is to develop and test an innovative strategy to improve linkage to and retention in hepatitis C virus (HCV) treatment among individuals recently released from jail. Dr. Matthew Akiyama is proposing a K99/R00 career development and research plan which will prepare him to develop interventions to improve linkage to and retention in HCV care among individuals with criminal justice system involvement. HCV is the leading cause of cirrhosis and hepatocellular carcinoma in the United States and, as of 2007, superseded HIV as a cause of death. A strong interrelationship with substance use disorders has led to epidemic proportions of HCV in correctional settings, with a prevalence of 17.4% compared with a national HCV prevalence of only 1.3%. Care coordination programs improve linkage to care among HIV+ individuals leaving correctional settings, yet no prospective studies have evaluated the strategy of care coordination for HCV+ individuals leaving correctional settings. In addition, while peers have been used in diverse settings to address barriers to medical care and are effective at increasing health knowledge, reducing risk behaviors, and facilitating linkage to health care, peer interventions have not been studied for HCV+ individuals leaving correctional settings. Dr. Akiyama has been a key contributor to the development of a care coordination intervention for improving linkage to HCV treatment that is currently underway in the New York City jail system. This proposal builds on this experience and extends it in several important ways. The goal of the mentored (K99) phase of this proposal is to provide Dr. Akiyama with sufficient training in four key skills: 1) advanced qualitative/mixed methods research, 2) developing behavioral interventions, 3) design and conduct of randomized controlled trials in correctional settings, and 4) statistical analysis of longitudinal and clustered data specific to criminal justice populations. During the mentored (K99) phase of the award we will achieve the following specific aims: 1) To identify barriers to and facilitators of linkage to care in an existing HCV care coordination program and 2) To use the barriers and facilitators identified in Aim 1 to design an enhanced, tailored, care coordination intervention with peers as a central component. In the independent R00 phase of the award, we will 3) test the feasibility and effectiveness of the peer- enhanced, tailored, care coordination intervention using a randomized design. We hypothesize that the tailored intervention, enhanced by peers, will lead to greater rates of linkage to HCV treatment, treatment initiation, treatment completion, sustained virologic response, and lower rates of HCV risk behavior. Completion of the proposed pilot trial during the R00 phase along with intensive mentorship during the K99 phase will prepare Dr. Akiyama to test the peer-enhanced care coordination intervention in a multisite randomized controlled trial in a future R01. The proposed K99/R00 award will provide training, mentorship, and research experience that will serve as the foundation for Dr. Akiyama's career as an independently funded clinical investigator dedicated to improving health outcomes for HCV+ individuals with criminal justice system involvement.

摘要 这项研究的总体目标是开发和测试一种改进联系的创新战略 最近出狱的人接受和保留丙型肝炎病毒(丙型肝炎病毒)治疗。Dr。 Matthew Akiyama正在提出K99/R00职业发展和研究计划，这将使他做好准备 制定干预措施，以改善刑事司法人员与丙型肝炎病毒护理的联系和保留 系统参与。丙型肝炎病毒是美国肝硬变和肝细胞癌的主要原因 而且，自2007年起，它已取代艾滋病毒成为一种死亡原因。与物质使用障碍有很强的相互关系 导致了惩教场所丙型肝炎的流行比例，与前一年相比，感染率为17.4% 全国丙型肝炎感染率仅为1.3%。护理协调计划改善艾滋病毒+患者与护理的联系 离开教养场所的个体，但还没有前瞻性研究评估护理策略 为离开惩教场所的丙型肝炎病毒感染者提供协调。此外，虽然对等节点已在 多样化的环境，以解决医疗保健的障碍，并有效地增加健康知识，减少 危险行为，以及促进与医疗保健的联系，同伴干预尚未对丙型肝炎病毒+进行研究 离开教养所的人。秋山医生一直是护理发展的关键贡献者 协调干预，以改善与丙型肝炎病毒治疗的联系，目前正在纽约进行 城市监狱系统。这项建议建立在这一经验的基础上，并在几个重要方面加以扩展。的目标是 该提案的指导(K99)阶段是为秋山博士提供四项关键技能方面的充分培训：1) 高级定性/混合方法研究，2)开发行为干预，3)设计和实施 在矫正环境中的随机对照试验，以及4)纵向和成群的统计分析 专门针对刑事司法人口的数据。在获奖的指导(K99)阶段，我们将实现 以下具体目标：1)确定现有丙型肝炎病毒治疗的障碍和与护理联系的促进者 护理协调计划和2)使用目标1中确定的障碍和促进者来设计 增强的、量身定制的护理协调干预，以同行为中心组成部分。在 独立R00阶段的颁奖，我们将3)测试同行的可行性和有效性- 采用随机设计的增强型、量身定制的护理协调干预。我们假设 由同行加强的量身定制的干预将导致更高的与丙型肝炎治疗、治疗的关联率 启动、治疗完成、持续的病毒学应答和较低的丙型肝炎病毒危险行为发生率。 在R00阶段完成拟议的试点试验，并在K99期间进行密集指导 阶段将为秋山博士做好准备，以便在多个地点测试同行增强的护理协调干预 未来R01的随机对照试验。拟议的K99/R00奖项将提供培训、指导和 研究经验，将作为秋山博士独立资助的职业生涯的基础 致力于改善刑事司法系统丙型肝炎病毒+患者健康结局的临床调查员 参与其中。