Renal transplant Equity through Partnership And Structural Transformation (REPAST)

摘要 肾移植(KTX)被认为是终末期肾病患者的首选治疗方法。 疾病。尽管最近肾脏分配发生了变化，但黑人和西班牙裔患者不太可能 接受KTX，这是一个多步骤的过程，需要患者转介、患者内科/外科/心理社会 评估和病人等待名单。因为没有标准化的、可接受的社会心理测量标准 评估，每一步都受到提供者和患者偏见的影响，并受到社会决定因素的阻碍 经常被忽视的结构性种族主义继续推动KTX的种族和族裔差距。我们 已确定KTX评估和等待上市的障碍和推动者，包括提供商偏见、高 未满足的健康和血液透析患者症状负担的社会决定因素。要解决这个问题 结构性种族主义对KTX的影响，我们现在提议与一个 执行利益相关者董事会和工作组，由患者、临床医生、护理人员、倡导者、 以及透析组织和移植中心的系统负责人。这项工作将建立在2 数十年的社区参与的研究和试验，以改善不同人群的健康。我们会 与董事会合作，根据我们团队和其他人过去的工作制定干预措施， 辅以对患者、护理者和临床医生的形成性访谈。提高……的税率 接受KTX评估的患者、慢性肾脏疾病患者导航员和等待名单 对于肾脏移植或移植接受者自己将引导患者完成移植 评估过程。这将包括进行社交需求筛选和解决障碍 未被覆盖，包括便利任命，以解决未得到满足的需求，如粮食不安全和 交通、症状控制和心理健康挑战。提高轮候上座率 在那些被评估的人中，我们将识别来自KTX提供商的污名化语言；注意并提供 一项反偏见倡议，包括对KTX肾病学家的评估和教育进行结构性改革。 我们将在320名成年人的临床试验中评估这种多因素干预的影响。 EGFR&lt；20ml/min/1.73m2或中心血液透析，主要结果是等待移植。 我们还将共同制定如何开展这项工作的蓝图，以便在全国范围内使用 减少不平等，并为政策、制度和做法提供信息。我们的董事会将作为一个持久的 为将来的肾脏权益工作提供资源。

Abstract Kidney transplantation (KTx) is considered the preferred treatment for patients with end-stage kidney disease. Despite recent changes to the kidney allocation Black and Hispanic individuals are less likely to receive KTx, a multi-step process requiring patient referral, patient medical/surgical/psychosocial evaluation, and patient waitlisting. As there are no standardized acceptable metrics for psychosocial evaluations, each of steps is impacted by provider and patient bias and thwarted by social determinants often overlooked and structural racism continues to drive of racial and ethnic disparities in KTx. We have identified barriers and facilitators to evaluation and waitlisting for KTx, including provider bias, high unmet social determinants of health and symptom burden in patients on hemodialysis. To address the impact of structure racism on KTx, we now propose a multi-level intervention in full partnership with an Executive Stakeholder Board and Workgroups comprised of patients, clinicians, caregivers, advocates, and system leaders for dialysis organizations and transplant centers. This work will be built on 2 decades of community-engaged research and trials to improve health in diverse populations. We will work with the Board to develop an intervention based on past work by our team and others, supplemented by formative interview with patients, caregivers, and clinicians. To increase rates of patients receiving KTx evaluation, patient navigators who have chronic kidney disease and waitlisted for kidney transplant or are transplant recipients themselves will guide patients through the transplant evaluation process. This will include conducting a social needs screen and addressing barriers uncovered, including facilitating appointments to address unmet needs such as food insecurity and transportation, control of symptoms and mental health challenges. To increase rates of waitlisting among those evaluated, we will identify stigmatizing language from KTx providers; notes and provide an anti-bias initiative including structural changes to evaluation and education for KTx nephrologists. We will evaluate the impact of this multifactorial intervention in a clinical trial among 320 adults with an eGFR <20ml/min/1.73m2 or on in-center hemodialysis with a primary outcome of transplant waitlisting. Together, we will also develop a blueprint of how to conduct this work, so that it can be used nationally to reduce inequities and inform policies, systems and practices. Our Board will serve as a durable resource for future kidney equity work.