Chronic kidney disease (CKD) is a significant public health problem affecting over 30 million US adults, who are at increased risk for hospitalization, cardiovascular disease, progression to end-stage renal disease, and death. African Americans are disproportionately affected by CKD, experiencing a four-fold greater incidence of end-stage renal disease than Whites. Receipt of high-quality primary care for patients with CKD creates opportunities for patients to identify and treat their risks for CKD progression and represents a key strategy for both improving patients'clinical outcomes overall and for addressing racial disparities in CKD progression. Evidence suggests that, overall, the primary care of patients with CKD (including patients'appropriate utilization of primary care services, primary care providers'appropriate management of CKD, and high-quality patient-physician discussions about CKD) is lacking. Studies identifying the contribution of suboptimal primary care to racial disparities in CKD outcomes have not previously been performed. Further, mechanisms through which interventions to improve primary care might narrow disparities are unknown. The overall objectives of this proposal are to: 1) conduct a retrospective cohort study to quantify differences in the utilization of primary care services and the quality of CKD care among African American and Whites with CKD and explore the contribution of these differences to racial disparities in CKD outcomes, 2) conduct a cross- sectional study to identify key system-, provider-, and patient-level factors contributing to racial disparities in utilization and quality of CKD care in primary care settings, and 3) conduct a prospective cohort study of African Americans with CKD, to assess the quality of patients'interactions with their primary care providers about CKD, and to explore the association of high-quality interactions with patients'improved understanding and self-management of their risks for CKD progression. The candidate for this mentored Career Development Award, Dr. Raquel Greer, is a General Internist and Assistant Professor of Medicine at Johns Hopkins University School of Medicine and her long-term career goal is to establish her independence as a patient-oriented researcher addressing mechanisms leading to ethnic/racial disparities in CKD. During the award, Dr. Greer will undergo a rigorous didactic and research program, including an advanced, intensive set of didactic courses, seminars, and practical research experience that will substantially build her skills in developing and studying interventions to address ethnic/racial disparities in the care of patients with CKD. These career development activities will be conducted within the rich training environment of Johns Hopkins Center to Eliminate Cardiovascular Disparities and the Welch Center for Prevention, Epidemiology, and Clinical Research with direct guidance from outstanding mentors and advisors with expertise in studying the health care and clinical outcomes of patients with CKD, health disparities research, and other related research methods. These activities will provide Dr. Greer with a solid foundation for her successful transition toward gaining independent funding as a clinician investigator skilled in performing studies to address ethnic/racial disparities in te clinical care and outcomes of patients with CKD.

Public Health Relevance

Ethnic/racial minorities are more frequently affected by chronic kidney disease than non-minorities, and they experience worse clinical outcomes than non-minorities. Providing patients with high-quality primary care is a key strategy for improving their health outcomes overall and for addressing race differences in health outcomes. This application will fund studies to understand ways in which primary care providers can improve the health of minority and non-minority patients with chronic kidney disease.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rankin, Tracy L
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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Wang, Virginia; Diamantidis, Clarissa J; Wylie, JaNell et al. (2017) Minding the gap and overlap: a literature review of fragmentation of primary care for chronic dialysis patients. BMC Nephrol 18:274
Tseng, Eva; Greer, Raquel C; O'Rourke, Paul et al. (2017) Survey of primary care providers' knowledge of screening for, diagnosing and managing prediabetes. J Gen Intern Med 32:1172-1178
Mathioudakis, Nestoras N; Giles, Monica; Yeh, Hsin-Chieh et al. (2016) Racial differences in acute kidney injury of hospitalized adults with diabetes. J Diabetes Complications 30:1129-36
Greer, Raquel C; Liu, Yang; Crews, Deidra C et al. (2016) Hospital discharge communications during care transitions for patients with acute kidney injury: a cross-sectional study. BMC Health Serv Res 16:449
Greer, Raquel; Boulware, L Ebony (2015) Reducing CKD risks among vulnerable populations in primary care. Adv Chronic Kidney Dis 22:74-80
Greer, Raquel C; Ameling, Jessica M; Cavanaugh, Kerri L et al. (2015) Specialist and primary care physicians' views on barriers to adequate preparation of patients for renal replacement therapy: a qualitative study. BMC Nephrol 16:37
Abdel-Kader, Khaled; Greer, Raquel C; Boulware, L Ebony et al. (2014) Primary care physicians' familiarity, beliefs, and perceived barriers to practice guidelines in non-diabetic CKD: a survey study. BMC Nephrol 15:64
Ephraim, Patti L; Hill-Briggs, Felicia; Roter, Debra L et al. (2014) Improving urban African Americans' blood pressure control through multi-level interventions in the Achieving Blood Pressure Control Together (ACT) study: a randomized clinical trial. Contemp Clin Trials 38:370-82
Purnell, Tanjala S; Auguste, Priscilla; Crews, Deidra C et al. (2013) Comparison of life participation activities among adults treated by hemodialysis, peritoneal dialysis, and kidney transplantation: a systematic review. Am J Kidney Dis 62:953-73
DePasquale, Nicole; Ephraim, Patti L; Ameling, Jessica et al. (2013) Selecting renal replacement therapies: what do African American and non-African American patients and their families think others should know? A mixed methods study. BMC Nephrol 14:9

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