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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)

基本信息

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
项目类别：
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

项目摘要

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.

摘要