CKD awareness and self-management: Interventions for Safety-Net Patients

描述(由申请人提供)：这是为加州大学旧金山分校的肾病学家Delphine Tuot博士再次提交的K23奖项。Tuot博士在以患者为导向的慢性肾脏疾病(CKD)临床研究中确立了自己作为一名年轻研究员的地位。这一K23奖项将为Tuot博士提供必要的支持，以实现以下目标：(1)成为实施干预措施的专家，以改善CKD患者的健康结果，特别是那些在安全网环境下接受护理的患者；(2)在临床研究中实施先进的生物统计学方法；(3)发展定性研究方法方面的专业知识；(4)发展独立的临床研究事业。为了实现这些目标，Tuot博士组建了一个由两位主要导师领导的指导团队，一位是加州大学旧金山分校杰出教授、医学副主席、旧金山综合医院医学部主任Neil Powe博士，他的研究项目侧重于改善CKD的差异；另一位是UCSF肾脏科主任、CKD结局研究专家徐志远博士。她的更大的指导团队还包括玛格丽特·汉德利博士和查尔斯·麦卡洛克博士，前者是全国公认的弱势群体实施研究领域的领导者，后者是加州大学旧金山分校生物统计学部门的负责人，也是重复测量的纵向分析专家。丹尼尔·多汉博士在以慢性病为重点的定性研究方法方面拥有专业知识，他将担任非常密切的合作者。慢性肾脏病在美国成年人中很常见，并与过高的死亡率和发病率有关。在CKD患者中，改善健康结局的循证治疗(医学和行为)一直没有得到很好的采用。缺乏翻译的部分原因可能是患者对慢性肾脏病的认识较低，这可能会不成比例地影响安全网人口。Tuot博士的研究将考察CKD意识对患者行为和健康结果的影响(目标1)，并调查使用新型电话技术的循证CKD特定自我管理计划是否通过提高患者对CKD的自我效能和更多地参与降低风险的行为来影响CKD的进展(目标2)。此外，她将确定安全网患者在疾病管理中的感知角色，以及他们参与减缓CKD进展的行为的未得到满足的需求。她的定量和定性研究结果将完善AIM 2中的电话干预，并为新的基于文本的CKD患者自我管理支持计划的开发和管理提供信息，这些患者可能不参与电话干预(AIM 3)。这项研究将为评估疗效的多中心临床试验奠定基础。 以及各种自我管理计划在不同CKD患者中的健康结果的有效性，将在K奖励期结束前的R01拨款申请中提出。

DESCRIPTION (provided by applicant): This is a re-submission for a K23 award for Dr. Delphine Tuot, a nephrologist at the University of California, San Francisco. Dr. Tuot is establishing herself as a young investigator in patient-oriented clinical research of chronic kidney disease (CKD). This K23 award will provide Dr. Tuot with the support necessary to accomplish the following goals: (1) to become an expert in the implementation of interventions that improve health outcomes for patients with CKD, in particular those who receive care in a safety-net setting; (2) to implement advanced biostatistical methods in clinical studies; (3) to develop expertise in qualitative research methods and (4) develop an independent clinical research career. To achieve these goals, Dr. Tuot has assembled a mentoring team led by two primary mentors, Dr. Neil Powe, Distinguished Professor, Vice-Chair of Medicine at UCSF and Chief of Medicine at San Francisco General Hospital, whose research program focuses on improving CKD disparities; and Dr. Chi-yuan Hsu, Professor, Chief of Nephrology at UCSF and expert in CKD outcomes research. Her larger mentoring team also includes Dr. Margaret Handley, a nationally recognized leader in the field of implementation research in vulnerable populations and Dr. Charles McCulloch, Head of the Division of Biostatistics at UCSF and expert in longitudinal analyses for repeated measures. Dr. Daniel Dohan, who has expertise in qualitative research methods with a focus on chronic disease, will serve as a very close collaborator. CKD is common in the U.S. adult population and is associated with excess mortality and morbidity. There has been poor adoption of evidence-based therapies (medical and behavioral) that improve health outcomes among CKD patients. The lack of translation may be in part due to low patient awareness of CKD, which may disproportionately affect safety-net populations. Dr. Tuot's research will examine the impact of CKD awareness on patient behaviors and health outcomes (Aim 1) and investigate whether an evidence-based CKD-specific self-management program using novel telephone technology, impacts CKD progression through increased patient self-efficacy regarding CKD and greater engagement in risk-reduction behaviors (Aim 2). Additionally, she will identify safety-net patients' perceived role in disease management and their unmet needs to engage in behaviors that slow CKD progression. Results of both her quantitative and qualitative studies will refine the telephone intervention in Aim 2 an inform the development and administration of a new text-based self-management support program for safety-net patients with CKD who may not engage with telephone interventions (Aim 3). This research will form the basis for a multi-center clinical trial assessing the efficacy and effectiveness of various self-management programs on health outcomes among diverse patients with CKD, to be proposed in an R01 grant application before the end of the K award period.