Health system outreach to eliminate disparities in living kidney transplants

项目摘要 尽管他们的终末期肾病发病率是 白人，非洲裔美国人的早期活体肾移植（LDKT）率较低， 终末期肾病的最佳治疗方法。在接受LDKT方面的差异 在过去的十年里恶化了。至少有四个关键的障碍阻碍了病人的旅程沿着 获得LDKT的途径，包括缺乏对LDKT需求的认识;贫困 了解LDKT，难以与家人和医生讨论LDKT;不经常或 早期移植评估的转诊缓慢;难以完成多步骤 移植评估过程。非裔美国人可能更频繁地面临这些关键的 与其他人相比的障碍。同时进行严格的干预研究 解决这些关键障碍的办法并不存在。卫生系统有许多能力 （包括信息和人力资源），可以创造性地利用这些资源来解决 造成不平等的LDKT的多重关键障碍。然而，量化研究 利用和协调卫生系统资源的干预措施的有效性， 减轻LDKT差异尚未进行，留下了证据空白。我们建议 研究一项创新的干预措施，“卫生系统监测和外展”，旨在 克服导致最不发达国家之间差距的多重障碍。我们将进行比较 量化“卫生系统监测和外展”的有效性试验 与通常的护理相比，以减轻LDKT中的种族差异。我们的研究将在 美国南部的两个大型卫生系统，其中肾脏疾病的差异非常大， 这是一个普遍存在的问题，也是最迫切需要LDKT的地方。卫生系统监测和 外联将把监测登记册纳入电子卫生信息系统， 尽早公平地确定所有潜在的优先或早期LDKT候选人， 患者的实验室数据和经验证的计算机生成的肾脏疾病进展风险 预测算法移植社会工作者和协调员，他们已经嵌入在 移植团队，将'接触'确定潜在的LDKT候选人，以帮助他们解决 环境因素（包括教育、社会、后勤和导航需求）， 设置路障我们的两个主要结果将衡量患者的开始和完成 肾移植评估的数据我们还将测量 我们的导航支持在肾移植评估过程中的有效性。本研究 将为消除南部和全国的LDKT差距提供必要的证据。

PROJECT SUMMARY Despite their nearly four-fold greater incidence of end stage kidney disease compared to Whites, African Americans have lower rates of early living donor kidney transplantation (LDKT), an optimal treatment for end stage kidney disease. Disparities in receipt of LDKT have worsened over the past decade. At least four critical roadblocks hinder patients’ journey along the path to receiving LDKTs, including their lack of awareness of their need for LDKT; poor knowledge of LDKT and difficulties discussing LDKT with family and physicians; infrequent or sluggish referrals for early transplant evaluations; and difficulty completing the multi-step transplant evaluation process. African Americans may more frequently face these critical roadblocks when compared to others. Rigorously studied interventions simultaneously addressing these critical roadblocks do not exist. Health systems have numerous capabilities (including information and staffing resources) that could be creatively leveraged to address the multiple critical roadblocks to LDKT that contribute to disparities. However, studies quantifying the effectiveness of interventions which harness and coordinate health system resources to mitigate LDKT disparities have not been performed, leaving an evidence gap. We propose to study an innovative intervention, “Health System Surveillance and Outreach,” designed to overcome multiple roadblocks which lead to LDKT disparities. We will conduct a comparative effectiveness trial to quantify the effectiveness of ‘Health System Surveillance and Outreach’ compared to usual care to mitigate race disparities in LDKT. Our study will be conducted within two large health systems in the Southern US, where disparities in kidney disease are extremely prevalent, and where LDKT is most desperately needed. Health System Surveillance and Outreach will integrate a surveillance registry into electronic health information systems to identify all potential candidates for pre-emptive or early LDKT early and equitably by using patients’ laboratory data and a validated computer-generated kidney disease progression risk prediction algorithm. Transplant social workers and coordinators, who are already embedded in transplant teams, will ‘reach out’ to identified potential LDKT candidates to help them address contextual factors (including educational, social, logistical, and navigation needs) that pose roadblocks to LDKT. Our two primary outcomes will measure patients’ initiation and completion of kidney transplant evaluations using health system records. We will also measure the effectiveness of our navigation support on the kidney transplant evaluation process. This study will provide evidence needed to eliminate LDKT disparities in the South and across the nation.