An Individuation Intervention to Reduce Socioeconomic Disparities in Chronic Kidney Disease Care

Browse trials for

• Renal Insufficiency, Chronic 3,090

Keywords

• Individuation

Renal Insufficiency, Chronic

3,090 studies on the registry are indexed under Renal Insufficiency, Chronic; 698 are open to participants now.

This study's planned enrollment of 216 is above the median of 73 across 2,157 interventional studies indexed under Renal Insufficiency, Chronic.

Lead sponsor

Brigham and Women's Hospital is the lead sponsor of 1,267 studies on the registry; 228 are open to participants now.

Of its 116 completed or terminated interventional studies of FDA-regulated products, 65 (56%) have results posted.

Eligibility criteria

Study arms

• Experimental
  Intervention

  Implicit bias training + individuation

  Behavioral: Individuation + Implicit Bias Training

• Experimental
  Control

  Implicit bias training alone

  Behavioral: Implicit Bias Training Alone

Interventions

• BehavioralIndividuation + Implicit Bias Training

  This includes nephrologists taking Implicit Association Tests (IATs) and an unconscious bias in medicine course (\~45-60 min.) Those in the intervention arm will then meet with the study team for a 5-10-minute training on individuation, including examples of individuation-based questions. Nephrologists will be encouraged to design and tailor these questions to their own communication styles to facilitate natural conversations about patients' personal characteristics beyond their medical conditions. Each nephrologist will decide how to incorporate this into their visits (e.g., a smartphrase in a note template).

• BehavioralImplicit Bias Training Alone

  This includes nephrologists taking Implicit Association Tests (IATs) and an unconscious bias in medicine course (\~45-60 min.)

Primary outcomes

1. Percentage of CKD quality metrics achieved

   This includes receipt of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARBs), receipt of sodium-glucose co-transporter-2 inhibitors (SGLT2-Is), and measurement of spot albumin/creatinine ratio. For patients with CKD Stages 3a-5, this will also include measurement of hemoglobin, calcium, PTH, phosphate, 25-OH-vitamin D, referral for dialysis access placement (if indicated), and referral to transplant (if indicated)

   Time frame: 90 days

Secondary outcomes

1. Blood Pressure

   Percent at goal (SBP \<120) 6 months after appointment

   Time frame: 180 days

2. Change in creatinine/eGFR

   Change in creatinine and eGFR at 6 months compared to baseline

   Time frame: 180 days

3. Change in spot albumin/creatinine ratio

   Change in spot albumin/creatinine 6 months compared to baseline

   Time frame: 180 days

4. Stereotype activation

   After each encounter, providers will list the first three patient characteristics that come to mind, which 15 coders blinded to the study purpose will independently rate for low-SES stereotype content on a 1-5 scale, with ratings averaged across coders and characteristics to generate a patient-level stereotype activation score.

   Time frame: Date of visit (+7 day lag time)

5. Patient-provider care management discussion

   The patient-provider care management discussion will be operationalized in 3 ways: (1) which quality metrics are discussed (yes/no), (2) their order (rank), and (3) discussion length (seconds). Recorded encounters will be transcribed verbatim with speaker designations and time stamps and analyzed in steps involving coding.

   Time frame: Date of visit

6. Providers' communication style

   Providers' communication style will be analyzed using Linguistic Inquiry and Word Count (LIWC), which categorizes words into \>70 linguistic and psychological categories (e.g., pronouns, social words, affect) and calculates the percentage of words in each category.

   Time frame: Date of visit

7. Patient satisfaction with care

   Patient satisfaction with care assessed using the 'Patient Satisfaction Questionnaire', with a minimum score of 1 and maximum score of 5. A higher score means a better outcome i.e. extremely satisfied.

   Time frame: Date of visit

8. Patient centeredness

   Patient centeredness assessed using the 'Revised Patient Perception of Patient-Centeredness Questionnaire', with a minimum score of 1 and maximum score of 4. A higher score means a better outcome i.e. excellent patient centeredness.

   Time frame: Date of visit

9. Patient interpersonal trust in the provider

   Patient interpersonal trust in the provider assessed using the 'Trust in Physician Scale', with a minimum score of 1 and maximum score of 5. A higher score means a better outcome i.e. high trust in the provider.

   Time frame: Date of visit