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Home-based chronic kidney disease (CKD) care in Native Americans of New Mexico: a disruptive innovation
Investigator (PI): Shah, Vallabh O
Performing Organization (PO): (Current): University of New Mexico, School of Medicine, Department of Biochemistry and Molecular Biology / (505) 272-5148
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2017
Final Year: 2022
Record Source/Award ID: PCORI/AD-1511-33553
Funding: Total Award Amount: $2,263,251
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: An estimated 31 million people in the United State have chronic kidney disease (CKD). The present PCORI addressing disparity responsive proposal capitalizes on the currently established PCORI-funded pilot study at the University of New Mexico, using a model of home-based kidney care (HBKC) in Zuni Indians. Our preliminary data of HBKC study in Zuni showed increased levels of disease-specific knowledge and self-efficacy/disease self-management, and improvement in clinical outcomes. We are partnering with the Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC); its parent organization, the Albuquerque Area Indian Health Board, Inc. (AAIHB); the 27 Indian Health Service (IHS) Albuquerque-area tribes; and external scientific partners. Our proposed aims are to translate and compare effectiveness of multidisciplinary HBKC interventions to bolster patient levels of kidney-specific knowledge, self-efficacy, and CKD self-management, enabling patients to carry out the recommendations in a culturally sensitive way. Aim 1 is to screen 600 participants from four different American Indian tribes in New Mexico, utilizing point-of-care testing, to identify incident cases of CKD as well as participants for the proposed study of HBKC. Aim 2 is to perform a 12-month randomized trial comparing the HBKC group versus the delayed intervention (DI) group, to demonstrate improvement in patient activation measures (PAM) and adherence to treatment. We will demonstrate that CKD clinical risk profiles will improve with HBKC, as compared with DI, at 12 months and 18 months post-intervention. Aim 3 is to demonstrate that HBKC will improve psychological factors that map onto important cultural variations in treatment efficacy and health outcomes. Specifically, we will show improvement in potential mediators (e.g., treatment engagement, self-efficacy, coping, and increased knowledge) and moderators (e.g., stigma, chronic stress, depression, and health literacy) of health disparity and outcome. Study outcomes: The outcomes to be measured are (aim 1) the PAM and adherence measures; (aim 2) changes in clinical phenotypes, including UACR, A1c, body weight, body mass index, fasting glucose, blood pressure, and plasma lipids; and (aim 3) changes in quantitative traits, such as food intake and scores from a battery of mental health, self-efficacy, and quality-of-life instruments. Health impact: The active participation of the New Mexico's Native American community leadership and partnership of the AASTEC, the AAIHB, four tribes in the IHS Albuquerque area, and the University of New Mexico Health Sciences Center, along with the affordability of CHR personnel, renders the outcomes that will be demonstrated by this proposal easily sustainable over the long term. If successful, this program has the potential to change best practices for CKD prevention and to reduce health disparities in a cost-effective and sustainable manner.
MeSH Terms:
  • Blood Glucose
  • Blood Pressure
  • Comparative Effectiveness Research
  • Cultural Characteristics
  • Depression /complications
  • Health Literacy
  • Health Status Disparities
  • Healthcare Disparities
  • Humans
  • Indians, North American
  • New Mexico
  • Outcome Assessment, Health Care
  • Patient Compliance
  • Patient-Centered Care
  • Point-of-Care Testing
  • Program Development
  • Renal Insufficiency, Chronic /*ethnology
  • /*therapy
  • Self Care
  • Stress, Psychological /complications
  • Universities
Country: United States
State: New Mexico
Zip Code: 87131
UI: 20164023
CTgovId: NCT03179085
Project Status: Ongoing
Record History: ('2019: Project extended to 2022\n2017: Project extended to 2020',) ('Alternate Title: Providing at-home kidney disease care for Native Americans in New Mexico',)