NAVIGATE Kidney: A Multi-Level Intervention to Reduce Kidney Health Disparities

NAVIGATE Kidney：减少肾脏健康差异的多层次干预措施

• 批准号: 10742130
• 负责人: Lilia Cervantes
• 金额: $ 80.49万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 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/10742130
• 关键词: Address; American; American Indians; Arteriovenous fistula; Blood Vessels; Caring; Catheters; Chronic Kidney Failure; Colorado; Communities; Community Health Aides; Complex; Conflict (Psychology); Cost Effectiveness Analysis; Data; Dialysis procedure; Discrimination; Disparity; Education; Effectiveness; Ensure; Equity; Ethnic Population; Evaluation; Face; Family; Funding; Gender; Geography; Goals; Health; Health Care Sector; Health Insurance; Health Policy; Hemodialysis; Hispanic Populations; Home; Hospitalization; Improve Access; Incentives; Individual; Infection; Intervention; Kidney; Kidney Diseases; Kidney Failure; Kidney Transplantation; Language; Latino; Latino Population; Latinx; Latinx population; Learning; Measures; Methods; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; National Institute on Minority Health and Health Disparities; New Mexico; Organizational Policy; Participant; Patient-Centered Care; Patient-Focused Outcomes; Patients; Peritoneal Dialysis; Phenotype; Policies; Policy Maker; Poverty; Practical Robust Implementation and Sustainability Model; Procedures; Provider; Randomized; Randomized, Controlled Trials; Recommendation; Renal Replacement Therapy; Research; Schedule; Structural Racism; Structure; Testing; Transplant Recipients; Transplantation; United States Centers for Medicare and Medicaid Services; Venous; Visit; Waiting Lists; Work; arteriovenous graft; community engaged research; contextual factors; cost; cost effectiveness; cost-effectiveness evaluation; distrust; economic evaluation; effectiveness evaluation; effectiveness outcome; ethnic minority; experience; food environment; health disparity; health equity; health literacy; high risk; implementation context; implementation framework; implementation outcomes; improved; innovation; intervention participants; member; mortality; mortality risk; payment; person centered; primary outcome; racial minority; racial population; recruit; response; secondary outcome; shared decision making; social health determinants; standard care; trial comparing

PROJECT SUMMARY/ ABSTRACT Latinx (gender-inclusive term; includes Hispanics, Latino/a) experience a faster progression from chronic kidney disease (CKD) to kidney failure and face a disproportionate burden of structural racism and discrimination that contribute to kidney health disparities compared to non-Latinx Whites. Latinx individuals constitute the racial and ethnic group most likely to start dialysis with a central venous catheter. Compared to non-Latinx Whites, they are less likely to start recommended kidney replacement therapy (KRT) such as home dialysis and kidney transplant. Reducing the number of individuals who start KRT with a central venous catheter is critical because it is associated with a higher risk of fatal infection, non-fatal infection, hospitalization, and mortality compared to permanent vascular access. The Advancing American Kidney Health Initiative, a 2019 Presidential executive order, aims to improve access and quality of person-centered KRT. In response, the Centers for Medicare and Medicaid Services (CMS) launched kidney value-based payment models to improve patient-centered care; however, these models do not address the structural racism that operates across socioecological levels faced by racial and ethnic minorities with CKD. Our community- partnered team assessed how structural racism operates across socioecological levels among Latinx with kidney disease and in partnership with community, developed and tested NAVIGATE-Kidney, a multi-level, language and culturally concordant community health worker (CHW) intervention for Latinx on hemodialysis. We propose to partner with our community steering committees (CSCs) in Colorado and New Mexico to refine, adapt, and test NAVIGATE-Kidney for Latinx individuals with CKD stage 4/5 (eGFR 15-29 mL/min/1.73m2) (Aim 1). We will determine the effectiveness of NAVIGATE-Kidney compared to standard care by conducting a patient-level randomized controlled trial in 448 Latinx with CKD stage 4/5 (Aim 2). Our primary hypothesis is that intervention participants will have a lower rate of central venous catheter use at KRT start (primary outcome). Our secondary hypothesis is that intervention participants will have a higher rate of optimal KRT starts (composite secondary outcome), higher patient activation, and lower decisional conflict (patient-centered outcomes). To provide the most compelling data that will address structural racism, we will assess contextual factors and implementation outcomes using the innovative PRISM (Practical Robust Implementation and Sustainable Model) framework which aligns with parameters that policymakers consider to advance health equity (Aim 3). We will conduct a comprehensive economic evaluation including a cost-effectiveness analysis of NAVIGATE-Kidney to inform policy change (Aim 4). All the proposed work will be conducted in partnership with our community steering committee and patient partners. We will set up CSC structures and procedures to ensure authentic partnership, goal-setting, shared decision-making, and language equity.

项目总结/摘要 拉丁裔（包含性别的术语;包括西班牙裔、拉丁裔/a）从慢性 肾脏疾病（CKD）到肾衰竭，并面临结构性种族主义的不成比例的负担， 与非拉丁裔白人相比，导致肾脏健康差异的歧视。拉丁人 构成了最有可能开始使用中心静脉导管进行透析的种族和民族群体。相比 非拉丁裔白人，他们不太可能开始推荐的肾脏替代治疗（KRT），如家庭 透析和肾移植减少使用中心静脉导管开始KRT的人数 导管是至关重要的，因为它与致命性感染，非致命性感染， 与永久性血管通路相比的住院率和死亡率。先进的美国肾脏 健康倡议是2019年总统行政命令，旨在改善以人为本的医疗服务的获取和质量。 KRT。作为回应，医疗保险和医疗补助服务中心（CMS）推出了基于肾脏价值的 支付模式，以改善以病人为中心的护理;然而，这些模式并没有解决结构性种族主义 它在CKD的种族和少数民族所面临的社会生态层面上发挥作用。我们的社区- 一个合作团队评估了结构性种族主义如何在拉丁美洲的社会生态层面上运作， 肾脏疾病，并与社区合作，开发和测试NAVIGATE-Kidney，一种多层次， 语言和文化一致的社区卫生工作者（CHW）对Latinx进行血液透析干预。 我们建议与我们在科罗拉多和新墨西哥州的社区指导委员会（CSC）合作， 调整NAVIGATE-Kidney，并在患有CKD 4/5期（eGFR 15-29 mL/min/1.73 m2）的Latinx个体中进行测试 (Aim 1）。我们将通过开展一项研究，确定NAVIGATE-Kidney与标准治疗相比的有效性。 在448名患有CKD 4/5期的Latinx患者中进行的患者水平随机对照试验（目的2）。我们的主要假设是 干预参与者在KRT开始时中心静脉导管的使用率较低（主要 结果）。我们的次要假设是，干预参与者将有更高的最佳KRT率 启动（复合次要结局），患者激活程度较高，决策冲突较低（以患者为中心 成果）。为了提供解决结构性种族主义的最令人信服的数据，我们将评估背景 使用创新的PRISM（实用稳健实施和 可持续发展模式）框架，该框架与决策者为促进健康而考虑的参数相一致 公平（目标3）。我们会进行全面的经济评估，包括成本效益分析 NAVIGATE-KIDNEY为政策变化提供信息（目标4）。所有拟议的工作将在伙伴关系中进行 与我们的社区指导委员会和患者合作伙伴。我们将建立CSC结构和程序， 确保真正的伙伴关系、目标设定、共同决策和语言平等。