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

慢性肾脏病(CKD)是一种影响3000万美国人的全国性健康流行病， 在种族和少数民族人口中的代表性不成比例。在其最先进的形式中，CKD是 与生活质量差、不堪重负的症状负担和高死亡率有关。姑息性的，或者 支持性护理，是一种在症状管理、辅助医疗决策方面具有专长的专业- 制造和临终关怀。在肾脏疾病中，支持性护理往往没有纳入护理标准， 部分原因是缺乏证据和未能确定其交付的最佳模式。这项提议是“支持性的 《CKD中的关怀：实践范围和试点实施》旨在更多地了解 支持护理在当前肾脏病实践中的应用和检验实施综合护理的有效性 先进的CKD模范，同时学习基本的培训技能，成为一名独立的研究员。 具体地说，这是一项针对指导职业发展奖的三个目标的研究，该研究描述了目前 支持护理在非透析CKD患者护理中的整合范围及其与患者的关系 通过分析具有全国代表性的数据库报告结果；2)测试 将CKD IV期或V期患者的支持性护理与常规肾脏病护理相结合，采用随机试验， 在城市安全网医院进行的对照试验；以及3)确定有效或 应用定性和混合方法进行支持性护理干预未满足的需求 方法论。这三个目标是在比较中完成相辅相成的培训目标的同时实现的 在定量数据库分析、临床试验执行、 定性的、混合的方法方法论。 这项建议的结果将为肾病界提供有关传播的基本信息。 在非透析CKD护理中的支持性护理，这是一个有紧急支持性护理需求的人群。 此外，这项分析将确定CKD和危重关联中支持性护理获得方面的差异 缺乏支持性护理机会和患者报告的结果之间的差距。这项研究的第二阶段将 通过测试实施支持护理的效果推动肾脏病领域向前发展 先进的CKD在多种族人口中代表了CKD的人口结构。所获得的数据 这三个目标将提供有关社区支持性护理资源的基本数据， 增加获得肾脏支持性护理的潜在影响，实施新模式的可行性 在这一人群中的支持性护理，以及设计更大的多- 集中审判。这些目标将在发展我作为独立研究人员的技能的同时实现 让我将这些结果应用于决定性的试验，并有可能广泛改善对 许多美国人患有慢性肾脏病。

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.