Renal transplant Equity through Partnership And Structural Transformation (REPAST)

摘要 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，但黑人和西班牙裔个体不太可能 接受KTx，这是一个多步骤的过程，需要患者转诊，患者医疗/手术/心理社会 评估和患者等待名单。由于没有标准化的可接受的指标， 评估，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 经常被忽视和结构性的种族主义继续推动KTx的种族和族裔差异。我们 我已经确定了KTx评估和等待名单的障碍和促进因素，包括提供者偏见，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。解决 结构性种族主义对KTx的影响，我们现在建议与 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、倡导者组成， 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 数十年的社区参与研究和试验，以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， 辅以与患者、护理人员和临床医生的形成性访谈。为了提高 接受KTx评价的患者，患有慢性肾脏疾病和等待名单的患者导航员 对于肾移植或移植受者本身将指导患者通过移植 评估过程。这将包括进行社会需求筛查和消除障碍 未被发现的问题，包括促进任命，以解决粮食不安全等未得到满足的需求， 交通、症状控制和心理健康挑战。提高等待登记率 在接受评估的人中，我们将识别KTx提供者的侮辱性语言;注释并提供 一项反偏见倡议，包括对KTx肾科医生的评价和教育进行结构性改革。 我们将在一项临床试验中评估这种多因素干预对320名患有糖尿病的成人的影响。 eGFR <20 ml/min/1.73 m2或接受中心内血液透析，主要结局为移植等待名单。 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 减少不公平现象，并为政策、制度和做法提供信息。我们的董事会将作为一个持久的 未来肾脏权益工作的资源。

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.