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Multi-level Factors that Influence Dialysis Facilities' Assessments of Patient Suitability for Transplantation

Award Number: K01DK128384
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 04/01/2021
PERIOD OF PERFORMANCE END DATE: 01/31/2025

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Multi-level Factors that Influence Dialysis Facilities' Assessments of Patient Suitability for Transplantation - Project Summary/Abstract For most patients with end-stage renal disease (ESRD), kidney transplantation is the optimal treatment. Underserved racial/ethnic minority and low-income individuals have a greater burden of ESRD (higher incidence and more rapid progression), yet they have much poorer access to transplant. Before patients are considered for waitlisting at a transplant center, dialysis facility teams perform complex medical and psychosocial assessments of patients' suitability for transplant and decide whether to refer them to a transplant center for full evaluation. These pre-referral assessment processes, which vary widely across clinical teams, have been identified as among the most important potential drivers of downstream disparities in transplant waitlisting and receipt. The objective of this application for a NIDDK Mentored Research Scientist Development Award (K01) is to support an assistant professor at the Emory University Rollins School of Public Health to become an independent health services researcher fully equipped with the skills to build understanding of these patient assessment processes and to improve their treatment outcomes. To that end, this K01 award will provide training in clinical nephrology, qualitative and survey research methods, implementation science frameworks, and grant-writing. The research aims are designed to reinforce and apply these new skills and concepts in an investigation of dialysis facilities' pre-referral patient assessment processes. Specifically, the K01's research objective is to use rigorous qualitative and survey research methods to elucidate the measurable and modifiable provider-level constructs of cognitive load (stress, time pressure, disruptions) and uncertainty tolerance (anxiety or worry in response to uncertainty) and their impact on disparities in pre-referral assessments within their dialysis facility context. Aim 1 will use qualitative methods to explore how provider- level factors (e.g., cognitive load, uncertainty tolerance) and multi-level contextual factors (e.g., facility-level standard protocols, local transplant center policies) shape dialysis facility teams' processes for pre-referral patient assessment. Aim 2 will develop and validate a survey to quantify staff, dialysis facility, and community characteristics in the context of pre-referral assessments using a survey pilot and a rigorous modified Delphi approach. Aim 3 will conduct a survey of n≈2000 dialysis facility staff across 13 states and use linked data on patient transplant evaluation outcomes (referral, evaluation start, and waitlisting) to assess how staff cognitive load and uncertainty tolerance are related to racial/ethnic and socioeconomic disparities in transplant access as well as dialysis facility and community characteristics. The protected time, resources, and mentoring available through this career development award will enable Dr. Adam Wilk to emerge as an independent and leading researcher, conducting groundbreaking survey research and fostering the development and implementation of multi-level interventions to address barriers in access to transplant or other preferred treatments for underserved patients with kidney disease and other complex chronic conditions.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $146,963 )
2025	2025	TRUSTEES OF INDIANA UNIVERSITY	980 INDIANA AVE RM 2232	INDIANAPOLIS	IN	46202	MARION	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	5	2/19/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$146,963
2025	2025	TRUSTEES OF INDIANA UNIVERSITY	980 INDIANA AVE RM 2232	INDIANAPOLIS	IN	46202	MARION	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	004	5	6/4/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$88,743
2025	2025	TRUSTEES OF INDIANA UNIVERSITY	980 INDIANA AVE RM 2232	INDIANAPOLIS	IN	46202	MARION	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	002	5	2/27/2025	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$0
2025	2024	EMORY UNIVERSITY	201 DOWMAN DR NE	ATLANTA	GA	30322	DEKALB	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	2/19/2025	NON-COMPETING CONTINUATION	$0
2025	2024	EMORY UNIVERSITY	201 DOWMAN DR NE	ATLANTA	GA	30322	DEKALB	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	003	4	6/4/2025	NON-COMPETING CONTINUATION	-$88,743
														Subtotal = $146,963

Issue Date FY: 2024 ( Subtotal = $146,963 )
2024	2024	EMORY UNIVERSITY	201 DOWMAN DR	ATLANTA	GA	30322	DEKALB	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	1/24/2024	NON-COMPETING CONTINUATION	$146,963
														Subtotal = $146,963

Issue Date FY: 2023 ( Subtotal = $147,341 )
2023	2023	EMORY UNIVERSITY	201 DOWMAN DR	ATLANTA	GA	30322	DEKALB	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	3	1/30/2023	NON-COMPETING CONTINUATION	$147,341
														Subtotal = $147,341

Issue Date FY: 2022 ( Subtotal = $150,392 )
2022	2022	EMORY UNIVERSITY	201 DOWMAN DR	ATLANTA	GA	30322	DEKALB	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	1/19/2022	NON-COMPETING CONTINUATION	$150,392
														Subtotal = $150,392

Issue Date FY: 2021 ( Subtotal = $152,452 )
2021	2021	EMORY UNIVERSITY	201 DOWMAN DR	ATLANTA	GA	30322	DEKALB	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	3/8/2021	NEW	$152,452
														Subtotal = $152,452

Grand Total All Awards = $744,111

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Multi-level Factors that Influence Dialysis Facilities' Assessments of Patient Suitability for Transplantation

Award Number: K01DK128384

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 04/01/2021

PERIOD OF PERFORMANCE END DATE: 01/31/2025

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