Peer mentorship to improve outcomes in patients on maintenance hemodialysis

同伴指导可改善维持性血液透析患者的治疗效果

• 批准号: 10005348
• 负责人: Kerri Cavanaugh
• 金额: $ 52.68万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-06 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10005348
• 关键词: Accident and Emergency department; Address; Adherence; Albumins; Behavior; Cardiovascular Diseases; Caring; Chronic Disease; Clinical Trials; Complex; Control Groups; Dialysis patients; Dialysis procedure; Diet; Education; Educational Curriculum; Educational process of instructing; Emergency department visit; End stage renal failure; Evaluation; Failure; Geographic Locations; Geography; Goals; Health behavior; Healthcare Systems; Hemodialysis; Hospitalization; Hospitals; Hour; Intervention; Knowledge; Liquid substance; Location; Maintenance; Medical; Medicare; Mentors; Mentorship; Modeling; Morbidity - disease rate; Motivation; New York; Nutritional; Outcome; Outcome Study; Participant; Patient Care; Patient Education; Patients; Physicians; Population; Positioning Attribute; Provider; Randomized; Records; Research; Resources; Schedule; Self Efficacy; Self Management; Social Perception; Social support; Structure; Telephone; Testing; Training; Training Programs; Urea; Visit; Weight; Weight Gain; base; behavioral adherence; behavioral outcome; cardiovascular infection; cost; design; high risk; hospital utilization; hospitalization rates; improved; improved outcome; innovation; mortality; patient population; patient-level barriers; peer; peer coaching; pragmatic trial; primary outcome; programs; recruit; satisfaction; secondary outcome; self-management program; skills; therapy design; tool; treatment as usual; trial comparing; usual care arm

PROJECT SUMMARY / ABSTRACT The proposed project tests an intervention to improve outcomes in patients with end- stage renal disease (ESRD). Patients treated with hemodialysis are at disproportionally high risk for hospitalizations which are both costly to the health care system and are associated with high morbidity and mortality. A portion of hospitalizations in patients on hemodialysis are avoidable and may reflect a failure of self-management of dialysis parameters and adherence. Patient education that is provided by dialysis facilities focuses on dialysis quality metrics set by Medicare for reimbursement purposes. They seldom inform patients about concrete skills, nor do they increase self-efficacy with regards to behavioral outcomes. Patient level barriers to dialysis self-management include low knowledge about the relation of fluid metrics, dialysis adherence and dietary plans to short and long-term outcomes. We aim to employ the Information, Motivation and Behavior (IMB) Skills Model of improving adherence in medical care. We will use a peer mentorship model to provide information and motivation in order to improve adherence behaviors in patients with ESRD. Peer mentorship has been shown to increase theoretical and practical knowledge in patients with chronic disease, and peer-mentors increase perception of social support and self-efficacy in their mentees. We propose a pragmatic trial evaluating the effects of a peer-mentor program focused on increasing dialysis self-management in high risk patients on hemodialysis. Our primary outcome is the composite of emergency department visits and hospitalizations. Our study will be conducted in 2 geographic locations (Bronx, NY and Nashville, TN) to evaluate scalability and acceptability in different patient populations. We will recruit 20 peer mentors and train them using a curriculum based on the IMB model of improving adherence. Two hundred patients with ESRD will be recruited from 7 dialysis centers and will be randomized to either the peer mentorship intervention or a usual care control group. Trained mentors will implement a telephone intervention for 3 months and participants will be followed for an additional 15 months to evaluate study outcomes. This proposal is innovative and addresses challenges related to patient level barriers to self-management, high hospitalization rates and disproportionate morbidity and mortality with a low cost, scalable and pragmatic intervention.

项目概要/摘要 拟议的项目测试了一种干预措施，以改善终末期患者的预后 肾病阶段（ESRD）。接受血液透析治疗的患者的患病率不成比例地高 住院风险，这对医疗保健系统来说成本高昂，并且与 发病率和死亡率高。血液透析患者住院的一部分是 这是可以避免的，可能反映了透析参数和依从性自我管理的失败。 透析设施提供的患者教育侧重于透析质量指标 医疗保险用于报销。他们很少告知患者具体的技能，也很少告知患者具体的技能。 他们是否提高了行为结果方面的自我效能？患者层面的障碍 透析自我管理包括对液体指标、透析之间的关系知之甚少 短期和长期结果的坚持和饮食计划。我们的目标是雇用 提高医疗依从性的信息、动机和行为 (IMB) 技能模型 关心。我们将使用同伴指导模式来提供信息和动力，以便 改善 ESRD 患者的依从行为。同伴指导已被证明可以 增加慢性病患者和同伴导师的理论和实践知识 提高学员对社会支持和自我效能的认知。我们提出一个 评估以增加透析为重点的同行导师计划效果的务实试验 血液透析高危患者的自我管理。我们的主要结果是综合结果 急诊科就诊和住院治疗。我们的研究将在 2 地理位置（纽约州​​布朗克斯和田纳西州纳什维尔）来评估可扩展性和可接受性 不同的患者人群。我们将招募 20 名同伴导师并使用课程对他们进行培训 基于提高依从性的IMB模型。 200 名终末期肾病 (ESRD) 患者将 从 7 个透析中心招募，将被随机分配到同伴指导 干预组或常规护理对照组。训练有素的导师将实施电话 干预为期 3 个月，参与者将被额外跟踪 15 个月，以 评估研究结果。该提案具有创新性，解决了以下方面的挑战： 患者自我管理障碍、住院率高且不成比例 通过低成本、可扩展且务实的干预措施来降低发病率和死亡率。