Intensive Patient Referral and Education Program prior to Renal Replacement Therapy (iPREP RRT)

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PROJECT ABSTRACT African Americans with chronic kidney disease (CKD) experience disparities in the quality of their medical care, self-care and preparation for end stage renal disease (ESRD). Patient education can help African-American patients with advanced CKD decide to engage in self-care to delay progression to ESRD and about renal replacement therapy (RRT) treatment options. Hospitalization represents a “missed opportunity” to provide CKD education and ESRD planning to help patients make informed choices about their care that align with their preferences. Many patients are hospitalized within three months of dialysis initiation. The hospital also captures patients who are not otherwise well-linked to the medical system. In prior work our team developed and implemented PREP RRT, a culturally-tailored, multi-modality patient education intervention for hospitalized African American patients with advanced CKD using a racially concordant in-person educator and literacy- sensitive education materials. Our intervention was feasible and effective in increasing patient knowledge but was not intensive enough to change behavior. Thus, we used adapted an 12- week effective outpatient patient education program to complement our in-patient pilot program to increase patient knowledge, improve self- care behavior and strengthen linkage to care. In this proposal, we will conduct a randomized trial to test the effectiveness of the intensive PREP RRT intervention for hospitalized African American patients with advanced CKD with both a hospital-based intervention and a 12 week community-based intervention. We seek to increase patient knowledge, self-efficacy, self-management behavior, health seeking behavior, RRT planning and blood pressure control. We have assembled a strong team with skills in CKD health disparities, hospital- based and community-based interventions, randomized trial design, culturally-tailored patient-education, and theory-based intervention development. After successful completion of our aims, we will have developed an effective intervention that will reduce disparities by improving patient's CKD- related knowledge, behavior and care. We will also have the ability to disseminate the intervention across settings and to adapt the intervention for other patient populations.