A Hybrid Type 1 Effectiveness-Implementation Study of Education Strategies for Vascular Access Creation in Advanced Kidney Disease

7.项目摘要/摘要 在美国，超过75万人患有肾衰竭，其中大多数人接受血液透析治疗。尽管有证据- 基于建议经动静脉(AV)血管通路(瘘管或 80%的美国患者开始使用中心静脉导管进行血液透析，导致显著的发病率， 死亡率和医疗保健系统费用。此外，在及时创建的过程中存在明显的种族差异 影音接入。黑人患者开始血液透析时出现瘘管的可能性比白人患者低20%， 平均而言，年龄越小，合并症越少。患者报告延迟进行房室通路手术 因为恐惧，不愿开始透析，担心毁容，针头和疼痛，以及 对血管通路的了解不足。到目前为止，旨在增加对 建立透析前动静脉动静脉通路的循证建议侧重于系统，而不是 患者的教育和情感需求没有得到很好的满足。我们的中央 假设是通过量身定做的AV访问教育和支持来加强患者的准备将 提高血液透析开始前建立房室通路的比率，减少种族差异。好好应用-- 已建立的框架，我们将进行用户测试的混合类型1有效性-实施研究， 有效的教育包，提供血管通道健康信息并验证普通患者 情绪，通过动机访谈(MI)增加和不增加。具体来说，我们将进行一项 3-ARM，平行分组，3种教育策略的随机试验：聚焦血管通路教育 (教育)，MI增强的血管通路教育(Education-Plus)，没有重点的血管通路 在两个卫生系统对晚期CKD患者的教育(日常护理)1)比较 教育、教育加常规护理对提高预激综合征患者比例的有效性 2)确定影响#年教育战略实施的因素 以指导其在非审判环境下的公平翻译。我们将从以下几个方面评估教育策略 审查RE-AIM框架的相关要素：覆盖范围、有效性和实施。 重要的是，我们将确定黑人和白人患者的这些因素是否以及为什么不同。这 研究将产生关于以患者为中心的教育策略以改善血管的关键有效性数据 获取成果和关于执行情况的可采取行动的信息，以加速公平地采用 我们的发现，解决了血管准入护理方面的差异，并为将其他教育内容提供给 晚期CKD患者。

7. PROJECT SUMMARY/ ABSTRACT Over 750,000 people in the US have kidney failure, and most are treated with hemodialysis. Despite evidence- based guidelines recommending hemodialysis initiation via an arteriovenous (AV) vascular access (fistula or graft), 80% of US patients start hemodialysis with a central venous catheter, resulting in significant morbidity, mortality, and healthcare system expense. Additionally, there are stark racial disparities in the timely creation of AV access. Black patients are 20% less likely than White patients to start hemodialysis with a fistula despite, on average, being younger and having fewer comorbidities. Patients report delaying AV access surgery because of fear, reluctance to start dialysis, and worries about disfigurement, needles, and pain, as well as having an insufficient understanding of vascular access. To date, interventions aiming to increase uptake of the evidence-based recommendation for pre-dialysis AV access creation have focused on systems rather than patients, leaving unmet the well-documented educational and emotional needs of patients. Our central hypothesis is that strengthening patient preparedness through tailored AV access education and support will improve rates of AV access creation prior to hemodialysis initiation and reduce racial disparities. Applying well- established frameworks, we will conduct a hybrid type 1 effectiveness-implementation study of a user-tested, efficacious education package that provides vascular access health information and validates common patient emotions, with and without augmentation through motivational interviewing (MI). Specifically, we will conduct a 3-arm, parallel group, randomized trial of 3 education strategies: focused vascular access education (Education), MI-enhanced vascular access education (Education-Plus), and no focused vascular access education (Usual Care) among patients with advanced CKD at two health systems to 1) compare the effectiveness of Education, Education-Plus, and Usual Care for increasing the proportion of patients with pre- dialysis AV access creation, and 2) identify factors influencing the implementation of the education strategies in order to guide their equitable translation to the non-trial setting. We will evaluate the education strategies by examining relevant elements of the RE-AIM framework: Reach, Effectiveness, and Implementation. Importantly, we will determine whether and why these elements differ for Black and White patients. This research will yield critical effectiveness data about patient-focused education strategies to improve vascular access outcomes, and actionable information about implementation that will accelerate the equitable uptake of our findings, address disparities in vascular access care, and inform the delivery of other education content to patients with advanced CKD.