Patient Referral and Education Program prior to Renal Replacement Therapy (PREP RRT) Patient education prior to renal replacement therapy (RRT) leads to reduced central venous catheter use, improved access to self-care dialysis such as peritoneal dialysis, and increased access to transplantation. Each of these modalities has been shown to reduce morbidity and mortality and to improve quality of life for patients with end-stage renal disease (ESRD). African Americans are less likely than their White counterparts to receive nephrology care prior to dialysis initiation. African Americans are also less likely to hav a fistula for dialysis, to select peritoneal dialysis, and to appear on the renal transplant waitlit. Hospitalization may represent a missed opportunity to provide RRT education and planning to help patients make informed choices about their care that align with their preferences. Many patients are hospitalized within three months of dialysis initiation. The hospital may also capture patients who are not otherwise well-linked to the medical system. In addition, culturally-tailoring of health education messages through patient narratives has been found to be an effective means of increasing knowledge and motivating behavior change in African American patients. Therefore, I aim to develop, implement, and evaluate a patient-centered referral and education program for RRT (PREP RRT) that incorporates in- person education with a video of culturally-tailored patient narratives for hospitalized African American patients with advanced chronic kidney disease. To effectively implement these goals, I will develop expertise in qualitative research, health education design and behavioral interventions through coursework and mentorship. I have assembled a mentorship and research committee with expertise in reducing health disparities, qualitative methods, hospital-based interventions, multi-media education interventions and chronic kidney disease. I also will complete coursework in the Departments of Health Studies, Sociology and at the University of Illinois School of Public Health related to Survey Research, Qualitative Analysis and Behavior Change Interventions. Through successful implementation of this project, we aim to reduce health disparities and to decrease morbidity, mortality and health care utilization in patients with ESRD.
Improved patient education prior to renal replacement therapy (RRT) leads to reduced central venous catheter use, improved access to self-care dialysis such as peritoneal dialysis, and increased access to transplant for patients with end-stage renal disease (ESRD). Each of these modalities has been shown to reduce morbidity and mortality and to improve quality of life. While these modalities are underused overall, African Americans are less likely to have a fistula for dialysis, to select peritoneal dialysis, and to appear on the renal transplant waitlist than their White counterparts. This proposal seeks to develop, implement and evaluate a novel patient- centered referral and education program for RRT (PREP RRT) that incorporates in-person education with a video of culturally-tailored patient narratives for hospitalized African American patients with advanced chronic kidney disease (CKD). The data from this proposal will be critical for the development of future R-01 studies to assess the cost-effectiveness and impact on clinical and public health outcomes of this approach to education and referral for patients with advanced CKD and ESRD.
| Saunders, Milda R; Lee, Haena; Chin, Marshall H (2017) Early winners and losers in dialysis center pay-for-performance. BMC Health Serv Res 17:816 |
| Liu, Yuan; Vela, Monica; Rudakevych, Tanya et al. (2017) Patient factors associated with lung transplant referral and waitlist for patients with cystic fibrosis and pulmonary fibrosis. J Heart Lung Transplant 36:264-271 |
| Chen, Ling-Xin; Josephson, Michelle A; Hedeker, Donald et al. (2017) A Clinical Prediction Score to Guide Referral of Elderly Dialysis Patients for Kidney Transplant Evaluation. Kidney Int Rep 2:645-653 |
| Saunders, Milda R; Vela, Monica B (2016) Determinants and Outcomes of Nephrology Care. J Gen Intern Med 31:596 |
| Saunders, Milda R; Ricardo, Ana Catherine; Chen, Jinsong et al. (2016) Association between insurance status and mortality in individuals with albuminuria: an observational cohort study. BMC Nephrol 17:27 |
| Saunders, Milda R; Cifu, Adam; Vela, Monica (2015) Screening for Chronic Kidney Disease. JAMA 314:615-6 |
