减少肾移植机会不均(RaDIANT)地区研究:美国东南部随机试验

IF 8.5 1区 医学 Q1 UROLOGY & NEPHROLOGY Clinical Journal of the American Society of Nephrology Pub Date : 2024-12-13 DOI:10.2215/CJN.0000000586
Rachel E Patzer, Jade Buford, Megan Urbanski, Laura McPherson, Sudeshna Paul, Mengyu Di, Jessica L Harding, Goni Katz-Greenberg, Ana Rossi, Prince Mohan Anand, Amber Reeves-Daniel, Heather Jones, Laura Mulloy, Stephen O Pastan
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引用次数: 0

摘要

背景:美国东南部是全国肾移植率最低的地区之一,在移植机会方面存在种族和社会经济差异。我们评估了旨在增加佐治亚州(GA)、北卡罗来纳州(NC)和南卡罗来纳州(SC)早期移植机会和减少移植机会差异的多成分干预措施的有效性和实施情况:减少肾移植机会不均等(RaDIANT)地区研究将佐治亚州、北卡罗来纳州和南卡罗来纳州的 440 家透析机构随机分组,在 2018 年接受 RaDIANT 地区教育和质量干预或标准护理。主要结果是干预后透析开始一年内透析设施级移植转诊的变化,次要结果是检查转诊后六个月内评估开始的变化和评估开始一年内等待名单的变化。过程评估包括实施后调查(220 人)和半结构化员工访谈(4 人)。广义线性混合效应模型评估了整体干预效果和种族分组干预效果:在 440 家透析机构接受治疗的 25,586 名 ESKD 患者中,干预一年后两个干预组的转诊率都有所下降;但是,对照组(11.2% 降至 9.2%)与干预组(11.2% 降至 10.5%)相比,转诊率下降幅度更大。我们观察到,干预后,干预机构与对照机构中黑人患者的转诊可能性无明显差异(调整后的赔率[OR]:1.12,95% 置信区间[CI]:0.94-1.33);但干预后,干预机构中白人患者的转诊率明显增加(OR:1.24,95% 置信区间[CI]:1.02-1.51)。访谈强调了量身定制干预措施的重要性、联邦授权以及大型务实试验的实施挑战:干预后转诊率的下降反映了全国趋势;然而,一些接受干预的群体转诊率下降幅度较小,因此有必要进行长期跟踪。这些发现为今后在透析环境中修改和推广多层次、多成分干预措施提供了重要依据。
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Reducing Disparities in Access to Kidney Transplantation Regional Study: A Randomized Trial in the Southeastern United States.
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来源期刊
CiteScore
12.20
自引率
3.10%
发文量
514
审稿时长
3-6 weeks
期刊介绍: The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.
期刊最新文献
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