Improving access to renal transplantation for Underserved Black Communities

项目摘要 虽然黑人约占美国人口的14.6%，但在终末期肾病患者中， 35%的ESRD患者是黑人。治疗选择包括透析，但最好的结果（生存，生活质量， 成本）通过肾移植实现。然而，黑人ESRD患者不太可能因肾脏而转诊 移植评估--对终末期肾病患者的国家授权--不太可能被列为肾移植， 不太可能接受肾移植。正如FOA（RFA-DK-22-014）所概述的那样，结构性种族主义是一种 这是美国黑人ESRD患者健康结局存在明显种族差异的根本原因。 芝加哥是美国种族隔离最严重的城市之一，也是结构性种族隔离的一个很好的例子。 种族主义社区对黑人社区的投资减少，平均预期寿命接近30岁， 比富裕的白色人为主的芝加哥社区要低。为了抵消这些严重的 辛普森博士与黑人社区合作，建立并命名了第一个 最大的非洲裔美国人移植访问计划（AATAP）在全国，并享有国家 突出。该方案是一项多管齐下的干预措施，有四大支柱：1.文化融合，2。信任/激活， 3.健康知识，4。心理社会支持采取“保持真实。“（种族一致性， 提供者和患者，同情，肯定，访问时间和外行语言）的方法。 目标1.研究非洲裔美国人移植获取计划（AATAP）的影响， 缓解结构性种族主义，减少黑人ESRD患者的健康不平等 目标1.1。评估AATAP对患者健康相关生活质量、社会支持、 患者激活、自我效能、肾移植知识和歧视感知 目标1.2。评估AATAP对过程测量的影响（例如，上市时间、完成后处理、上市） 目标1.3。评估社区参与和AATAP信息传播对 转介接受肾移植 目标2：提高两个大型医院移植守门人的意识和结构能力 肾移植中心 目标2.1。研究黑人患者，提供者和团队成员在感知 通过定性访谈分析移植卫生系统内的歧视 目标2.2。进行反复性内隐偏见和结构性能力训练 目标2.3。评估随着时间的推移黑人患者的感知歧视 目的3：通过调整AATAP程序以适用于第二个大肾来证明其普遍性 坦帕佛罗里达的移植计划

Project Summary While Black persons account for approximately 14.6% of the US population, among those with end-stage renal disease (ESRD) 35% are Black. Treatment options include dialysis, but best outcomes (survival, quality of life, cost) are achieved with kidney transplantation. Yet, Black ESRD patients are less likely referred for kidney transplant evaluation - a national mandate for those with ESRD - less likely listed for kidney transplantation, less likely to receive a kidney transplantation. As outlined by the FOA (RFA-DK-22-014), structural racism is a fundamental cause of the stark racial disparity in health outcomes for Black patients with ESRD in the US. Chicago is one of the most segregated cities in the US and serves as an excellent example of structurally racist communities that have disinvested in Black communities with a mean life-expectancy that is almost 30 years lower than that of affluent predominantly White Chicago neighborhoods. To counteract these severe forces of structural racism, Dr. Simpson, engaged with the Black community to build and name the first and largest African American Transplant Access Program {AATAP) in the nation and has enjoyed national prominence. AATAP is a multi-pronged intervention with 4 pillars: 1. Cultural Congruency, 2. Trust/Activation, 3. Health Literacy, and 4. Psychosocial Support taking a 'Keeping it RE.A.LL.' (Racial concordance between provider and patient, Empathy, Affirmation, Length of visit and Lay person language) approach. Aim 1. To study the impact of African American Transplant Access Program (AATAP) designed to mitigate structural racism and reduce health inequities for Black ESRD patients Aim 1.1. To assess the impact of AATAP on patients' perception of health-related quality of life, social support, patient activation, self-efficacy, knowledge about kidney transplant and perception about discrimination Aim 1.2. To assess impact of AATAP on process measure {e.g., time to listing, completion of work-up, listing) Aim 1.3. To assess impact of community engagement and dissemination of information aboutAATAP on referral for kidney transplant Aim 2: To increase awareness and structural competency among transplant gatekeepers at 2 large kidney transplant centers Aim 2.1. To study the experience of Black patients, providers, and team members in terms of perception of discrimination within the transplant health system through qualitative interviews Aim 2.2. To perform recurrent implicit bias and structural competency training Aim 2.3. To assess perceived discrimination of Black patients over time Aim 3: To demonstrate generalizability by adapting the AATAP program to a second large kidney transplant program in Tampa Florida