Peer mentorship to improve outcomes in patients on maintenance hemodialysis

项目总结/摘要 拟议的项目测试了一种干预措施，以改善终末期肾病患者的预后， 肾疾病分期（ESRD）。接受血液透析治疗的患者， 住院风险，这对医疗保健系统来说是昂贵的， 发病率和死亡率高。血液透析患者的一部分住院治疗是 这是可以避免的，可能反映了透析参数和依从性的自我管理失败。 透析机构提供的患者教育侧重于透析质量指标， 医疗保险用于报销。他们很少告诉病人具体的技能，也 他们是否能提高自我效能感。患者水平障碍， 透析自我管理包括对液体指标、透析 坚持和饮食计划的短期和长期的结果。我们的目标是利用 提高医疗依从性的信息、动机和行为（IMB）技能模型 在乎我们将使用同伴指导模式来提供信息和动力，以便 改善ESRD患者的依从行为。同伴指导已被证明 增加慢性病患者的理论和实践知识，以及同行导师 提高学员对社会支持和自我效能的认识。我们提出了一个 一项评价同伴指导计划效果的实用性试验，该计划侧重于增加透析 血液透析高危患者的自我管理我们的主要结果是 急诊室就诊和住院的数量。我们的研究将在2 地理位置（纽约州布朗克斯和田纳西州纳什维尔），以评估 不同的患者群体。我们将招募20名同伴导师，并使用课程对他们进行培训 基于IMB的模型来提高依从性。200名终末期肾病患者将 从7个透析中心招募，并将随机分配到同行指导 干预组或常规护理对照组。经过培训的导师将通过电话 干预3个月，并对参与者进行额外15个月的随访， 评估研究结果。该提案具有创新性，解决了以下方面的挑战： 病人自我管理的障碍，高住院率和不成比例的 以低成本、可扩展和务实的干预措施降低发病率和死亡率。

PROJECT SUMMARY / ABSTRACT The proposed project tests an intervention to improve outcomes in patients with end- stage renal disease (ESRD). Patients treated with hemodialysis are at disproportionally high risk for hospitalizations which are both costly to the health care system and are associated with high morbidity and mortality. A portion of hospitalizations in patients on hemodialysis are avoidable and may reflect a failure of self-management of dialysis parameters and adherence. Patient education that is provided by dialysis facilities focuses on dialysis quality metrics set by Medicare for reimbursement purposes. They seldom inform patients about concrete skills, nor do they increase self-efficacy with regards to behavioral outcomes. Patient level barriers to dialysis self-management include low knowledge about the relation of fluid metrics, dialysis adherence and dietary plans to short and long-term outcomes. We aim to employ the Information, Motivation and Behavior (IMB) Skills Model of improving adherence in medical care. We will use a peer mentorship model to provide information and motivation in order to improve adherence behaviors in patients with ESRD. Peer mentorship has been shown to increase theoretical and practical knowledge in patients with chronic disease, and peer-mentors increase perception of social support and self-efficacy in their mentees. We propose a pragmatic trial evaluating the effects of a peer-mentor program focused on increasing dialysis self-management in high risk patients on hemodialysis. Our primary outcome is the composite of emergency department visits and hospitalizations. Our study will be conducted in 2 geographic locations (Bronx, NY and Nashville, TN) to evaluate scalability and acceptability in different patient populations. We will recruit 20 peer mentors and train them using a curriculum based on the IMB model of improving adherence. Two hundred patients with ESRD will be recruited from 7 dialysis centers and will be randomized to either the peer mentorship intervention or a usual care control group. Trained mentors will implement a telephone intervention for 3 months and participants will be followed for an additional 15 months to evaluate study outcomes. This proposal is innovative and addresses challenges related to patient level barriers to self-management, high hospitalization rates and disproportionate morbidity and mortality with a low cost, scalable and pragmatic intervention.