CommunityRx – Chronic Kidney Disease (CRx-CKD)” An EMR-integrated community resources referral intervention to address structural racism and kidney health disparities in rural North Carolina

CommunityRx — 慢性肾脏病 (CRx-CKD) — 一项与 EMR 整合的社区资源转诊干预措施，旨在解决北卡罗来纳州农村地区的结构性种族主义和肾脏健康差异

• 批准号: 10743421
• 负责人: Gaurav J Dave
• 金额: $ 76.19万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10743421
• 关键词: Academy; Address; Adult; Advocate; Affect; African American; African American population; Albuminuria; Algorithms; Attenuated; Behavior; Black Populations; Black race; Blood Glucose; Body Weight decreased; Body mass index; Cardiovascular Diseases; Caregivers; Caring; Censuses; Chicago; Chronic Kidney Failure; Clinic; Clinical; Communities; Consolidated Framework for Implementation Research; County; Death Rate; Development; Diabetes Mellitus; Disease Management; Disease Progression; Disparity; Effectiveness; Electronic Health Record; Eligibility Determination; Ensure; Environmental Exposure; Equity; Fostering; Glucose; Goals; Health; Health Personnel; High Prevalence; Home; Hyperlipidemia; Hypertension; Individual; Inequity; Infrastructure; Intervention; Kidney; Kidney Diseases; Kidney Failure; Medical; Modeling; North Carolina; Obesity; Outcome; Pathway Analysis; Patients; Persons; Policies; Poverty; Prevention; Process; Productivity; Public Health; Randomized, Controlled Trials; Renal Replacement Therapy; Research; Research Personnel; Resources; Rural; Rural Community; Science; Services; Structural Racism; Structure; Survey Methodology; System; Telephone; Testing; Text Messaging; Youth; access disparities; arm; blood lipid; blood pressure control; care coordination; care systems; community building; community clinic; cost effectiveness; disease disparity; disparities in morbidity; disparity reduction; eHealth; effectiveness testing; effectiveness/implementation study; evidence base; experience; foot; fortification; glomerular filtration; health care disparity; health disparity; health equity; health outcome disparity; hospitalization rates; implementation context; implementation science; improved outcome; integrated care; model building; multidisciplinary; multiple chronic conditions; novel; organizational readiness; point of care; post intervention; premature; primary care clinic; primary outcome; programs; racism; rural health clinic; rural setting; rurality; secondary outcome; segregation; social; treatment as usual; trend

Project Summary/Abstract Mitigating progressive chronic kidney disease (CKD) to avoid kidney failure is well known -- management of CKD and its multimorbidity (hypertension, diabetes, obesity, and cardiovascular disease). Yet unequal access to and utilization of quality medical and social resources present a significant and under-addressed barrier to optimal management, especially in rural settings. As advocated by the National Academies, we propose to address the endemic effects of structural racism and systemic drivers of health by using an intervention that integrates medical with social care for African Americans adults in rural eastern North Carolina. The intervention, CommunityRx (CRx), systematically matches people to nearby community resources using evidence-based algorithms at the point of care with a health care provider. CRx utilizes a three- pronged approach to address integrated care among patients and caregivers: (a) comprehensive, ongoing assessment of community resources (eligibility, capacity, quality) using feet-on-the street (see Meaningful Active Productive Science in Service to Communities (MAPSCorps) below) and phone survey methods; (b) integration of a simple automatic resource referral process into routine, Electronic Health Record (EHR)-based clinical workflows; and (c) availability of a community resource navigator. CRx for CKD (CRx-CKD) is an application of this infrastructural approach to address CKD multimorbidity. Our community-engaged and multidisciplinary health equity research team will leverage our infrastructural intervention and implementation science expertise to test the effects of CRx-CKD through three related aims. Aim 1 will contextualize implementation and effectiveness of a rural infrastructural integrated care intervention by (a) building an inclusive model with system science to describe how structural racism affects CKD progress on and its mitigation through integrated care; and (b) conducting a network analysis to evaluate structures of clinic-community connectivity. Aim 2 will optimize Crx-CKD implementation through the Consolidated Framework of Implementation Research to ensure organizational readiness, fidelity, and acceptability. With aim 3, we will test the effectiveness of the CRx-CKD intervention with a pragmatic cluster randomized controlled trial at the clinic level. Three hundred seventy-five African American individuals with CKD multimorbidity at the intervention clinics will be compared to 375 individuals at usual care clinics for the primary outcome of reduction of the glomerular filtration slope decline and reduction of albuminuria; other, secondary outcomes include control of blood pressure, control of blood sugar, weight reduction, and blood lipid management.

项目摘要/摘要 减轻进行性慢性肾脏疾病(CKD)以避免肾衰竭是众所周知的-- 慢性肾脏病及其多发病(高血压、糖尿病、肥胖和心血管疾病)的治疗 疾病)。然而，优质医疗和社会资源的获取和利用不平等 在最佳管理方面，特别是在农村环境中，存在着重大且未得到充分解决的障碍。AS 在国家科学院的倡导下，我们建议解决结构性疾病的地方性影响 种族主义和系统性健康驱动因素，采用将医学与社会相结合的干预措施 关爱北卡罗来纳州东部农村的非裔美国成年人。干预， Community Rx(CRX)，系统地将人们与附近的社区资源相匹配 在与医疗保健提供者进行护理时的循证算法。CRX利用了三个- 采取综合办法解决病人和照顾者之间的综合护理：(A) 对社区资源(资格、能力、质量)进行全面、持续的评估 街道上的脚(参见服务于社区的有意义的积极生产性科学 (下文MAPSCorps)和电话调查方法；(B)整合一个简单的自动资源 将转诊过程纳入基于电子健康记录(EHR)的常规临床工作流程；以及 社区资源导航器的可用性。CRX for CKD(CRX-CKD)就是这方面的一个应用 解决慢性肾脏病多病的基础设施方法。我们的社区参与和 多学科健康公平研究团队将利用我们的基础设施干预和 通过三个相关目标测试CRX-CKD效果的实施科学专业知识。 目标1将结合农村综合基础设施的实施和成效 护理干预：(A)用系统科学建立包容性模型，以描述 结构性种族主义影响CKD在综合护理方面的进展和缓解；以及(B) 进行网络分析以评估诊所-社区连通性的结构。目标2将 通过统一的实施框架优化CRX-CKD实施 确保组织准备就绪、忠诚度和可接受性的研究。在目标3中，我们将测试 CRX-CKD干预效果的语用分组随机对照研究 在临床层面上进行试验。375名患有慢性肾脏病的非裔美国人 干预诊所的多发病将与普通护理诊所的375人进行比较。 对于肾小球滤过斜率下降和肾小球滤过率降低的主要结果 蛋白尿；其他次要结果包括控制血压、控制血液 糖分、减肥和血脂管理。