A Culturally Targeted Transplant Program to Increase Live Donation in Hispanics

 描述(申请人提供)：用于终末期肾病(ESRD)患者肾移植的器官短缺在拉美裔美国人中被放大。与非西班牙裔白人相比，西班牙裔美国人的ESRD患病率高得不成比例，但接受的肾脏移植手术较少。活体供肾移植(LDKT)是终末期肾病(ESRD)的首选治疗方法，因为它能提高患者和移植物的存活率，缩短等待时间， 而且比已故的供体肾移植的生活质量更好。然而，与他们在等待名单上的代表相比，2013年获得LDKT的拉美裔美国人比非西班牙裔白人少：4%对10%。拉美裔美国人面临的障碍包括：缺乏知识、文化问题和语言障碍。如果不进行干预，这种差距可能会进一步加剧，因为拉美裔美国人是美国规模最大、增长最快的少数群体。现有的有文化能力的干预措施很少导致LDKT发生率增加。干预措施很少涉及拉美裔文化问题，也没有发表过仅以移植中心为基础的项目模式。芝加哥西北医学公司的西语裔肾移植计划(HKTP)是一项具有文化和语言能力的计划，增加了西语裔肾移植患者的人数。西班牙裔与非西班牙裔白人LDKT的年平均比例从2001年至2006年的0.2增长到2008年至2013年的0.34，增长了70%(p&lt；0.001)。这项研究的目的是在两个服务于大量拉美裔人群的移植中心(德克萨斯州达拉斯和加利福尼亚州洛杉矶)实施和评估HKTP，这是一种基于文化能力的移植中心干预措施，西北大学作为研究协调中心。HKTP干预前的研究将评估HKTP的主要文化敏感因素(外展、沟通、教育)对西班牙裔LDKT比率的影响，并与匹配的对照组进行比较。具体目标是：1.在两个移植中心实施HKTP，方法是对障碍进行需求评估，并使用“学习协作”模式交付HKTP协议、脚本和材料。2.与配对对照进行HKTP干预前评估，以评估HKTP是否与以下方面的增加有关：a)西班牙裔与非西班牙裔白人LDKT的比率作为西班牙裔LDKT绝对增加的函数，b)ESRD西班牙裔患者增加到等候名单，c)每名潜在接受者的西班牙裔潜在捐赠者，以及d)西班牙裔患者对护理的满意度。3.在两个研究地点对HKTP的外展、沟通和教育的保真度和创新适应进行形式化评估，以确定HTKP的有效组成部分，采用混合方法。作为探索性目标，将进行预算影响分析，以构建移植中心的业务案例，并允许估计HKTP的可伸缩性。这项拟议的研究将提供有关迅速传播HKTP作为一种新方法的潜力的宝贵知识，以在全国范围内增加西班牙裔LDKT，改善拉美裔的健康结果，并缩小LDKT的差距。

 DESCRIPTION (provided by applicant): The shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans. Hispanics have a disproportionately higher prevalence of ESRD, yet receive fewer kidney transplants compared to non-Hispanic whites. Living donor kidney transplant (LDKT) is the treatment of choice for ESRD as it confers better patient and graft survival, shorter waiting time, and better quality of life than deceased donor kidney transplantation. However, compared to their representation on the waiting list, fewer Hispanics received a LDKT than non-Hispanic whites in 2013: 4 percent versus 10 percent. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and language barriers. The disparity will likely worsen without intervention as Hispanics are the largest and fastest growing minority group in the US. Few available culturally competent interventions have led to increased LDKT rates. Interventions rarely address Hispanic cultural concerns, and there are no published models of transplant center-based only programs. The Chicago Northwestern Medicine's(r) Hispanic Kidney Transplant Program (HKTP), a culturally and linguistically competent program, has increased Hispanic LDKTs. The mean annual ratio of Hispanic to non-Hispanic white LDKTs grew from 0.20 in 2001-2006 to 0.34 in 2008-2013, a 70 percent increase (p<0.001). The objective of this study is to implement and evaluate the HKTP, a culturally-competent transplant center-based intervention, at two transplant centers serving large Hispanic populations (Dallas, TX, and Los Angeles, CA), with Northwestern University serving as the Study Coordinating Center. The pre-post HKTP intervention study will evaluate the effect of the HKTP's key culturally sensitive components (outreach, communication, education) on Hispanic LDKT rates, compared to matched controls. The specific aims are to: 1. Implement the HKTP at two transplant centers by conducting a needs assessment of barriers and using a "learning collaborative" model to deliver HKTP protocols, scripts, and materials. 2. Conduct a pre-post HKTP intervention evaluation with matched controls to assess if the HKTP is associated with an increase in: a) the ratio of Hispanic to non-Hispanic white LDKTs as a function of an absolute increase in Hispanic LDKTs, b) ESRD Hispanic patient additions to the waiting list, c) Hispanic potential donors per potential recipient, and d) Hispanic patients' satisfaction with care. 3. Formatively evaluate the fidelity and innovative adaptations to HKTP's outreach, communication, and education at both study sites to identify effective components of the HTKP, using mixed methods. As an exploratory aim, a budget impact analysis will be conducted to construct a business case for transplant centers and permit estimates of HKTP scalability. The proposed study will provide valuable knowledge about the potential to rapidly disseminate the HKTP as a novel approach to increase Hispanic LDKTs nationally, improve health outcomes for Hispanics, and close the LDKT disparity gap.