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Supportive Care in Kidney Disease: Scope of Practice and Pilot Study of Implementation

肾脏疾病的支持治疗：实践范围和实施试点研究

基本信息

批准号：
10605215
负责人：
Jennifer S Scherer
金额：
$ 18.95万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-15 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10605215
关键词：
Address Advance Care Planning Affect American Award Caring Chronic Care Chronic Kidney Failure Clinic Clinical Trials Communities Comparative Effectiveness Research Complex Control Groups Data Databases Decision Making Dialysis procedure Disease Outcome Disparity Effectiveness Epidemic Ethnic Origin Ethnic Population Face Failure Foundations Goals Health Health Services Accessibility Hospitals Institution International Intervention Intervention Trial Interview K-Series Research Career Programs Kidney Kidney Diseases Knowledge Learning Medical Mentored Patient-Oriented Research Career Development Award Mentors Methodology Methods Modeling Multicenter Trials Nephrology Outcome Outcome Measure Palliative Care Participant Patient Outcomes Assessments Patient-Centered Care Patient-Focused Outcomes Patients Pattern Phase Pilot Projects Population Positioning Attribute Process Provider Public Health Quality of life Randomized, Controlled Trials Reporting Research Research Personnel Resources Structure Supportive care Symptoms Testing Time Training Uncertainty United States Work career caregiving clinical training clinical trial analysis comparison group demographics design disparity reduction effectiveness testing end of life care ethnic minority population experience health care disparity implementation science improved improved outcome innovation integrated care medical specialties minority communities minority patient mortality multi-ethnic outcome disparities patient oriented racial diversity racial minority population response safety net satisfaction skills skills training standard of care symptom management symptomatic improvement treatment arm treatment choice usual care arm

项目摘要

Chronic kidney disease (CKD) is a national health epidemic impacting 30 million Americans, with a disproportionate representation in racial and ethnic minority populations. In its most advanced forms, CKD is associated with poor quality of life, overwhelming symptom burden, and a high mortality. Palliative, or supportive care, is a specialty that has expertise in symptom management, assistance in medical decision- making, and end-of-life care. In kidney disease, supportive care often is not integrated in the standard of care, partly due to lack of evidence and failure to identify an optimal model for its delivery. This proposal, “Supportive care in CKD: Scope of practice and pilot implementation” seeks to learn more about the integration of supportive care in current nephrology practice and test the effectiveness of implementing an integrated care model in advanced CKD, while I learn essential training skills to become an independent researcher. Specifically, this is a three-aim study for a mentored career development award that 1) Describes the current scope of integration of supportive care in the care of non-dialysis CKD patients and its association with patient reported outcomes through analysis of a nationally representative database; 2) Tests the effectiveness of integrating supportive care with usual nephrology care in CKD stage IV or V patients using a pilot randomized, controlled trial conducted in an urban safety net hospital; and 3) Determines the mechanism of effectiveness or unmet needs of the supportive care intervention through application of qualitative and mixed-methods methodology. These three aims will be achieved while completing complementary training aims in comparative effectiveness research with specific training in quantitative data base analysis, clinical trial execution, qualitative, and mixed methods methodology. The results of this proposal will provide essential information to the nephrology community about dissemination of supportive care in the care of non-dialysis CKD care, a population with urgent supportive care needs. Furthermore, this analysis will identify disparities in supportive care access in CKD and critical associations between lack of supportive care access and patient reported outcomes. The second phase of this study will move the field of nephrology forward by testing the effectiveness of implementation of supportive care in advanced CKD in a multi-ethnic population representative of the demographics of CKD. The data obtained from these three aims will provide essential data regarding supportive care resources in the community, the potential impact of increasing access to kidney supportive care, the feasibility of implementing new models of supportive care in this population, and the statistical information necessary for the design of larger multi- centered trials. These aims will be accomplished while developing my skills as an independent researcher and positioning me to apply these results in definitive trials with the potential to broadly improve the care of the many Americans suffering from CKD.

慢性肾脏疾病（CKD）是一种影响3000万美国人的全国性健康流行病