Renal transplant Equity through Partnership And Structural Transformation (REPAST)

通过伙伴关系和结构转型实现肾移植公平 (REPAST)

• 批准号: 10743661
• 负责人: Lili Chan
• 金额: $ 85.91万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 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/10743661
• 关键词: Address; Adoption; Adult; Advocate; Appointment; Assessment tool; Black Populations; Black race; Caregivers; Chronic Kidney Failure; Clinical; Clinical Trials; Cluster randomized trial; Collaborations; Communities; Community Health Aides; Country; Data; Development; Dialysis patients; Dialysis procedure; Disparity; Education; Eligibility Determination; End stage renal failure; Enrollment; Ensure; Equity; Evaluation; Face; Fostering; Future; Health; Health system; Healthcare Systems; Hemodialysis; Hispanic; Hispanic Populations; Individual; Inequity; Intervention; Interview; Kidney; Kidney Failure; Kidney Transplantation; Label; Language; Lead; Link; Low income; Mediating; Medical; Medicine; Mental Depression; Mental Health; Operative Surgical Procedures; Pain; Patient Care; Patient-Focused Outcomes; Patients; Persons; Policies; Population Heterogeneity; Process; Provider; Race; Racial Equity; Renal Replacement Therapy; Research; Research Personnel; Resort; Resources; Social support; Standardization; Stigmatization; Structural Racism; Structure; Symptoms; System; Testing; Training; Transplant Recipients; Transplantation; Transportation; Waiting Lists; Work; community engaged research; compare effectiveness; design; ethnic disparity; experience; food insecurity; impression; improved; innovation; interest; optimal treatments; patient navigator; primary outcome; program dissemination; programs; psychosocial; racial discrimination; racial disparity; racism; recruit; social; social determinants; social health determinants; success; tool; transplant centers; treatment as usual

Abstract Kidney transplantation (KTx) is considered the preferred treatment for patients with end-stage kidney disease. Despite recent changes to the kidney allocation Black and Hispanic individuals are less likely to receive KTx, a multi-step process requiring patient referral, patient medical/surgical/psychosocial evaluation, and patient waitlisting. As there are no standardized acceptable metrics for psychosocial evaluations, each of steps is impacted by provider and patient bias and thwarted by social determinants often overlooked and structural racism continues to drive of racial and ethnic disparities in KTx. We have identified barriers and facilitators to evaluation and waitlisting for KTx, including provider bias, high unmet social determinants of health and symptom burden in patients on hemodialysis. To address the impact of structure racism on KTx, we now propose a multi-level intervention in full partnership with an Executive Stakeholder Board and Workgroups comprised of patients, clinicians, caregivers, advocates, and system leaders for dialysis organizations and transplant centers. This work will be built on 2 decades of community-engaged research and trials to improve health in diverse populations. We will work with the Board to develop an intervention based on past work by our team and others, supplemented by formative interview with patients, caregivers, and clinicians. To increase rates of patients receiving KTx evaluation, patient navigators who have chronic kidney disease and waitlisted for kidney transplant or are transplant recipients themselves will guide patients through the transplant evaluation process. This will include conducting a social needs screen and addressing barriers uncovered, including facilitating appointments to address unmet needs such as food insecurity and transportation, control of symptoms and mental health challenges. To increase rates of waitlisting among those evaluated, we will identify stigmatizing language from KTx providers; notes and provide an anti-bias initiative including structural changes to evaluation and education for KTx nephrologists. We will evaluate the impact of this multifactorial intervention in a clinical trial among 320 adults with an eGFR <20ml/min/1.73m2 or on in-center hemodialysis with a primary outcome of transplant waitlisting. Together, we will also develop a blueprint of how to conduct this work, so that it can be used nationally to reduce inequities and inform policies, systems and practices. Our Board will serve as a durable resource for future kidney equity work.

抽象的 肾移植（KTx）被认为是终末期肾病患者的首选治疗方法 疾病。尽管最近肾脏分配发生了变化，黑人和西班牙裔人的可能性较小 接受 KTx，这是一个多步骤过程，需要患者转诊、患者医疗/外科/心理社会 评估和患者候补名单。由于没有标准化的可接受的心理社会指标 评估中，每个步骤都受到提供者和患者偏见的影响，并受到社会决定因素的阻碍 经常被忽视的结构性种族主义继续加剧 KTx 的种族和民族差异。我们 已确定 KTx 评估和候补名单的障碍和促进因素，包括提供商偏见、高 血液透析患者健康和症状负担的未满足的社会决定因素。为了解决 为了应对结构性种族主义对 KTx 的影响，我们现在提议与 执行利益相关者委员会和工作组由患者、临床医生、护理人员、倡导者、 以及透析组织和移植中心的系统领导者。这项工作将建立在 2 数十年来社区参与的研究和试验旨在改善不同人群的健康。我们将 与董事会合作，根据我们团队和其他人过去的工作制定干预措施， 辅之以与患者、护理人员和临床医生的形成性访谈。提高比率 接受 KTx 评估的患者、患有慢性肾病且已列入候补名单的患者导航员 进行肾移植或移植受者本人将指导患者完成移植 评估过程。这将包括进行社会需求筛查并解决障碍 覆盖，包括促进任命以解决未满足的需求，例如粮食不安全和 交通、症状控制和心理健康挑战。提高候补率 在评估的对象中，我们将识别来自 KTx 提供商的污名化语言；注释并提供 一项反偏见倡议，包括对 KTx 肾病专家的评估和教育进行结构性改变。 我们将在一项临床试验中评估这种多因素干预的影响，该试验的参与者为 320 名患有以下疾病的成年人： eGFR <20ml/min/1.73m2 或正在进行中心血液透析，主要结果是移植等待。 我们还将共同制定如何开展这项工作的蓝图，以便在全国范围内使用 减少不平等并为政策、系统和实践提供信息。我们的董事会将作为一个持久的 未来肾脏公平工作的资源。