Kidney Awareness Registry and Education-2

肾脏意识登记和教育-2

• 批准号: 8964616
• 负责人: Delphine Tuot
• 金额: $ 57.18万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8964616
• 关键词: Address; Adherence; Adoption; Adult; Affect; African American; Albuminuria; Angiotensin Receptor; Angiotensin-Converting Enzyme Inhibitors; Asians; Awareness; Behavior; Blood Pressure; Cardiovascular system; Caring; Chronic Kidney Failure; Clinic; Clinical; Clinical Data; Communities; Community Health Centers; Computerized Medical Record; Data; Diabetes Mellitus; Diagnosis; Disease Management; Disease Progression; Education; Educational Materials; Effectiveness; Electronics; Excess Mortality; Feasibility Studies; Federally Qualified Health Center; Goals; Grant; Guidelines; Health; Health Communication; Health system; Hispanics; Individual; Intervention; Kidney; Kidney Diseases; Knowledge; Low Income Population; Low income; Measures; Medical Care Team; Mentored Patient-Oriented Research Career Development Award; Minority Groups; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Patient Recruitments; Patients; Persons; Pharmaceutical Preparations; Population; Prevalence; Primary Health Care; Proteinuria; Provider; Publishing; Qualifying; Randomized; Randomized Controlled Trials; Regimen; Registries; Research; Research Infrastructure; Risk Reduction Behavior; San Francisco; Scientific Advances and Accomplishments; Self Efficacy; Self Management; Staging; System; Telephone; Text; Translating; Translations; Work; abstracting; base; behavioral outcome; blood pressure regulation; chronic care model; clinical care; disease registry; effective intervention; evidence base; experience; glycemic control; health care delivery; healthy lifestyle; high risk; improved; literacy; mortality; multi-component intervention; outreach; point of care; population health; primary outcome; programs; provider intervention; public health relevance; safety net; satisfaction; treatment as usual

 DESCRIPTION (provided by applicant): Enhancing CKD health: Kidney Awareness Registry and Education-2 (KARE-2) trial Abstract Chronic kidney disease (CKD) is common, causes excess mortality and morbidity, and is associated with socio-demographic disparities with respect to prevalence and clinical outcomes. Measures such as glycemic control in persons with diabetes, blood pressure control, and reduction of proteinuria with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) can help delay CKD decline and decrease CKD-associated morbidity and mortality; however, many individuals with CKD are not benefiting from these scientific advances. This lack of translation may be due in part to very low levels of CKD awareness among providers and patients leading to inadequate primary care provider self-efficacy for delivery of CKD care and poor patient engagement to participate in healthy lifestyles and adhere to medication regimens. To address this need, our multi-disciplinary team has developed and piloted two interventions that increasing awareness among providers and patients and translate that knowledge into more optimal CKD care. The provider intervention is a CKD registry tailored to the entire healthcare team that provides point-of-care decision support regarding CKD management and outside-of care summaries of CKD relevant clinical data to optimize delivery of guideline-concordant CKD care via outreach and population health. The patient intervention is a comprehensive self-management support program that includes low-literacy educational materials, linguistically/culturally tailored automated telephone self-management support (CKD-ATSM), health coaching, and reminder text messages. Our team has successfully piloted both interventions in a pilot feasibility study (NCT01530958) in one academic clinic that serves a low-income, multilingual population. We have since refined the interventions to integrate the registry with the electronic medical record and to include mobile texting in the self-management program. We are now poised to study the effectiveness of the refined interventions on health outcomes among a large diverse, low-income population using the Chronic Care Model framework of health care delivery. We propose a 2x2 factorial randomized controlled trial entitled Kidney Awareness Registry and Education-2 (KARE-2), in which we will randomize 60 providers and 400 patients with CKD in 6 federally qualified community health centers to receive the provider intervention (CKD registry) or usual care and the patient self- management support intervention (CKD-ATSM) or usual care. We will assess the impact of the provider intervention component of KARE-2 (Aim 1); the patient intervention component of KARE-2 (Aim 2); and their interaction (Aim 3) on patient-level clinical outcomes (e.g., blood pressure, CKD decline); provider behavioral outcomes (e.g., provider self-efficacy for CKD management); and patient behavioral outcomes (e.g., CKD awareness, participation in self-management behavior). If one or both KARE-2 interventions are effective at improving health among high-risk patients, they can be disseminated to other delivery systems to change the way CKD care is delivered in the US, leading to reductions in CKD-associated morbidity and mortality.

 描述（由申请人提供）：增强 CKD 健康：肾脏意识登记和教育 2 (KARE-2) 试验 摘要 慢性肾脏病 (CKD) 很常见，导致死亡率和发病率过高，并且与患病率和临床结果方面的社会人口差异有关。糖尿病患者的血糖控制、血压控制以及使用血管紧张素转换酶抑制剂 (ACEi) 或血管紧张素受体阻滞剂 (ARB) 减少蛋白尿等措施有助于延缓 CKD 衰退并降低 CKD 相关发病率和死亡率；然而，许多慢性肾病患者并没有从这些科学进步中受益。这种缺乏转化的部分原因可能是由于提供者和患者对 CKD 的认识水平非常低，导致初级保健提供者提供 CKD 护理的自我效能感不足，以及患者参与健康生活方式和坚持用药方案的积极性较差。为了满足这一需求，我们的多学科团队开发并试点了两种干预措施，以提高提供者和患者的认识，并将这些知识转化为更优化的 CKD 护理。提供者干预是针对整个医疗团队量身定制的 CKD 登记，提供有关 CKD 管理的即时决策支持和 CKD 相关临床数据的护理外摘要，以通过外展和人口健康优化提供符合指南的 CKD 护理。患者干预是一项全面的自我管理支持计划，包括低识字率教育材料、根据语言/文化定制的自动电话 自我管理支持 (CKD-ATSM)、健康指导和提醒短信。我们的团队在一个为低收入、多语言人群服务的学术诊所的试点可行性研究 (NCT01530958) 中成功试点了这两种干预措施。此后，我们改进了干预措施，将登记与电子病历整合在一起，并将手机短信纳入自我管理计划。我们现在准备使用医疗保健提供的慢性护理模型框架来研究针对大量多元化低收入人群的健康结果的精细干预措施的有效性。我们提出了一项名为“肾脏意识登记和教育-2”(KARE-2) 的 2x2 因子随机对照试验，其中我们将在 6 个联邦合格的社区卫生中心随机抽取 60 名提供者和 400 名 CKD 患者，接受提供者干预（CKD 登记）或常规护理以及患者自我管理支持干预（CKD-ATSM）或常规护理。我们将评估 KARE-2 的提供者干预部分的影响（目标 1）； KARE-2 的患者干预部分（目标 2）；以及它们对患者临床结果（例如血压、CKD 下降）的相互作用（目标 3）；提供者行为结果（例如，提供者对 CKD 管理的自我效能）；以及患者行为结果（例如 CKD 意识、自我管理行为参与）。如果一项或两项 KARE-2 干预措施能够有效改善高危患者的健康状况，则可以将其传播到其他提供系统，以改变美国 CKD 护理的提供方式，从而降低 CKD 相关发病率和死亡率。