Supportive Understanding and Patient-centered Partnership for Optimizing Renal Treatment (SUPPORT)

University of Pennsylvania

Status: Completed

Conditions: Chronic Kidney Diseases; Trauma, Psychological; Racism, Systemic

Treatments: Behavioral: IMPaCT Community Health Worker Program; Other: Trauma-Informed Care Training

Study type: Interventional

Funder types: Other

Identifiers

NCT06378476

855188

Details and patient eligibility

About

Black and Hispanic people face higher risks of chronic kidney disease (CKD) but have unequal access to the highest-quality kidney care. Black adults with CKD face 1.5 times higher hospitalization risks than non-Black adults with CKD. Once reaching end stage kidney disease (ESKD), Black patients are half as likely to receive a transplant and are often excluded from home dialysis. Structural racism creates complex barriers to optimal CKD care, providing an explanation for these findings. The Penn Medicine IMPaCT Community Health Worker (CHW) program is a rigorously tested approach to employ people from local communities to dismantle structural racism within health care systems and improve outcomes for marginalized patients. This trial will innovate by training CHWs to focus specifically on CKD care for minoritized people. The investigators will also train primary care clinicians caring for CKD patients on how to provide trauma-informed care (TIC). The first aim is to determine the feasibility, acceptability, and reach of a clinic-level TIC training to address the needs and concerns of Black and other minoritized patients. The second aim will be to conduct a three arm trial comparing individuals in usual care to individuals randomized to either our tailored CHW intervention in conjunction with clinic-level TIC training or to clinic-level TIC intervention only. The investigators will examine whether patients in the intervention arms have greater improvements in quality of life (primary). The investigators will also explore the impact of the interventions on patient activation, hospitalizations, and ESKD treatment preferences.

Enrollment: 153 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Chronic kidney disease stage 4 or 5
• Patient at participating general internal medicine or family medicine clinic
• Medicaid-eligible or uninsured
• Reside in high poverty Philadelphia zip code

Exclusion criteria

• No history of kidney transplant
• Not receiving any form of dialysis
• Not previously enrolled with a community health worker in the past 2 years

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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153 participants in 3 patient groups

CHW + TIC

Experimental group

Description:

Patients in this arm will receive 6 months of support from a community health worker as well as primary care from a clinic where clinicians and staff have undergone trauma-informed care training.

Treatment:

Other: Trauma-Informed Care Training

Behavioral: IMPaCT Community Health Worker Program

TIC only

Experimental group

Description:

Patients in this arm will receive primary care from a clinic where clinicians and staff have undergone trauma-informed care training.

Treatment:

Other: Trauma-Informed Care Training

Usual Care

No Intervention group

Description:

Patients in this arm will receive usual care.