Cycle 2 (2023): Penn LDI Research Initiative on Improving Management of Chronic Kidney Disease
We are seeking proposals of up to $350,000 for research projects, each lasting up to 18 months and focused on generating rigorous new evidence that will advance the U.S. health care system’s capacity to effectively identify, manage, and improve outcomes of patients with CKD. Projects that address implications for health equity and projects that focus on reducing health disparities will be given preference (described further below). The methodological approach of these projects should be chosen to best answer the research question, and could include observational studies using existing sources of data and rigorous methodological approaches, prospective development and testing of interventions, or the application of implementation science methods.
Form of Intent Deadline: Friday, September 29th at 11:59 p.m ET
Application Deadline: Tuesday, October 31st at 11:59 p.m. ET
We will prioritize research projects that are broadly focused on improving care delivery for adult patients with CKD, including those patients in earlier disease stages, reducing health disparities, and are particularly interested in projects in the following three areas:
Improving access to specialty providers: Lack of access to nephrologists and other specialty providers is a major barrier to optimal care of CKD and management of its comorbidities, such as hypertension and diabetes. Improving access to specialized care is a key step to slowing the progression of CKD. Possible research topics may include but are not limited to:
- Developing approaches to improve identification and risk stratification of individuals with CKD at high risk for progression and costly complications such as hospital admissions
- Developing predictive models to identify patients with CKD who are not receiving care from a nephrologist
- Testing innovative technology and data-driven care delivery models to improve access to specialty care. Examples might include tools such as telemedicine or chatbots;
- Testing more effective use of the existing specialty care workforce. Examples might include use of team-based care; or partnerships between primary care and specialty care.
Improving uptake of evidence-based treatment to prevent progression of CKD: Despite a substantial knowledge base about effective diagnostic and therapeutic approaches for individuals with CKD, they often do not receive evidence-based care from their providers or do not implement recommended therapies. Possible research topics may include but are not limited to:
- Identifying and evaluating innovative approaches to facilitate health engagement for individuals with CKD to increase use of and adherence to evidence-based care and improve outcomes.
- Testing interventions and care delivery strategies that encourage increased use of evidence-based care by providers for individuals with CKD. Possible interventions may include nudges, feedback and benchmarking for providers, or novel financial incentives. Investigators may also propose methods to reduce the burden of CKD, for instance by reducing complications or improving patient reported outcomes.
- Developing new evidence of the impact of existing interventions on the uptake of evidence-based therapies for CKD, optimal transition to ESRD care, use of home-based ESRD care, and referral to transplant. Examples of interventions might include provider feedback and quality ratings, provider financial incentives, or other related programs targeting improved care delivery.
Improving the financing and delivery models to improve care for individuals with CKD and ESRD: Care for people with advanced CKD is often fragmented, with providers working in silos that do not communicate well, and stems from perverse economic incentives that prevent optimal care for patients, with in-center hemodialysis as a default pathway. This can result in under-referral and underutilization of therapies like kidney transplantation, of cost-effective therapies that improve quality of life such as home-based dialysis, and of palliative care approaches that may be most consistent with some patients’ values. Possible research topics may include but are not limited to:
- Developing and testing interventions to improve care coordination or address misaligned financial incentives between dialysis providers and other providers including transplant centers and palliative care providers
- Developing and testing care delivery models that successfully support patients in the early transition to dialysis, when hospitalizations and mortality rates are elevated.
- Evaluating existing policies or developing and testing new strategies to facilitate living kidney donor transplantation, including reducing barriers to living kidney donor evaluation and/or increasing health equity for access to living donor kidney transplant.
- Identifying strategies to decrease time patients spend on kidney transplant waiting lists, including resolution of inactive status or appropriate consideration of transplants from older or comorbid deceased donors.
- Identifying and testing care delivery models that integrate palliative care into nephrology practices and dialysis units
- Evaluating approaches to increase use of peritoneal dialysis and home hemodialysis. Possible approaches may include patient education, addressing misaligned provider incentives, or models or interventions that increase home-based support.
We invite LDI Senior Fellows to propose ideas for research projects lasting up to 18 months. Awarded projects are expected to begin on January 8, 2024.
An Advisory Committee, made up of LDI members, Monogram Health, and other kidney disease experts, will be available to guide the direction of accepted projects, including connections to academic experts and operational partners within their purview.
Projects funded under this initiative may be able to gain access to patient data collected by Monogram Health related to its programs. However, the quality of proposals will not be evaluated based on their use (or non-use) of data or other resources and connections from Monogram Health. Penn LDI resources include assistance in translation and dissemination of completed research.
- If you have any questions please consult LDI’s FAQ, view LDI’s Q&A webinar here, or email Nadiyah Browning.
- If you have an idea but are unsure whether your project is feasible within this framework or proposed timeline, or if you have questions about Monogram data and would like to speak to Monogram’s Epidemiologist, please email Nadiyah Browning.
Available Data on Monogram Health
Monogram Health is a next-generation, value-based, chronic condition specialty provider serving patients living with chronic kidney and end-stage renal disease as well as their related metabolic disorders. Monogram seeks to fill systemic gaps and transform the way nephrology, primary care, and chronic condition treatments are delivered. Monogram’s innovative, in-home approach utilizes a suite of technology-enabled clinical services, including benefit management and complex care coordination services that improve health outcomes while lowering medical costs across the health care continuum. By increasing access to evidence-based care pathways and addressing social determinants of health, Monogram has emerged as an industry leader in championing greater health equity and slowing the progression of chronic kidney disease.
As part of the ongoing relationship between Penn LDI and Monogram Health, research proposals submitted through the Penn LDI Research Initiative on Improving Management of Chronic Kidney Disease have the option of obtaining access to Monogram Health data for research purposes. Note: Use of Monogram Health data is not a requirement of this RFP.
Monogram Health Member Data
Longitudinal data is available on approximately 16,000 patients enrolled in Monogram Health’s services. Information includes:
- Disease state and progression
- A1C measures
- Blood pressure measures
- Social determinants of health
- Zip code data
- Mortality information
- Social Determinants of Health
- Clinical Diagnosis
- Disease Progression
Additional electronic health record (EHR) data is available from patients under direct management through the Monogram Kidney Care Practice. Athena Health is utilized by Monogram Practice employees and connects to CareConnect Health and Carequality to aggregate clinical information from providers outside of the Monogram Practice.
Medical and Pharmacy Claims Data
Claims are available on approximately 65,000 members attributed to Monogram Health from nine partners, including two national insurers. These claims include 34 states, and primarily cover the Southeast, Mid-South, West, North, and Gulf regions of the United States. Claim types include both medical and pharmacy claims data and are available for both Monogram Health enrolled and non-enrolled patients.
- Provider Identifier
- Procedure Codes
- Date and Place of Service
- Drug Dispensed (NDC)
Lab Test Results Data
Lab tests ordered by both Monogram-affiliated and non-affiliated providers are available on patients enrolled in Monogram-provided care.
- Lab Test Name
- LOINC Codes
- Result (Numeric and Text)
Proposals must be led by an LDI Senior Fellow. University of Pennsylvania faculty without LDI affiliations and LDI Associate Fellows are permitted to be co-investigators on proposals. Investigators outside Penn are permitted to be co- investigators if sufficient justification is provided for why their expertise is needed.
For investigators without substantial research expertise in the CKD domain, LDI may be able to provide connections to collaborators with that CKD expertise.
Application Process and Timeline
The Grant Review Committee will select up to two projects, each lasting 18 months. Applications are due Tuesday, October 31, 2023, at 11:59 p.m. ET.
Project budgets may not exceed a total of $350,000 (across entire timeline). Faculty salaries and benefits may be included in the budget only if there is a strong justification for doing so and the salaries and benefits combined must not exceed 30% of the award. Indirect costs will not be covered.
LDI plans to fund up to two proposals in this funding cycle. All proposals will be reviewed by the initiative’s Grant Review Committee, made up by LDI experts, a representative from Monogram Health, and other kidney disease experts; as needed, additional content experts will be asked to evaluate grants.
Proposals will be assessed against the following criteria:
- Impact. The project will have the potential for a meaningful and measurable impact on improving the delivery of care for individuals with CKD. Priority will be given to projects that will generate results that will lead to broad-based changes in practice or policy.
- Investigator(s) and Team. The qualifications of the PI and the background and experience of the investigator team.
- Methods. The methodological rigor and appropriateness of the scientific plan.
- Theme. Priority will be given to proposals focused on research aligned with the objectives of the LDI Research Initiative on Improving Management of Chronic Kidney Disease, listed above.
- Equity. Priority will be given to projects that address disparities in care for CKD, including structural barriers and racial inequities in care. Proposals must include a dedicated section explaining how the proposal will examine health equity, how health equity will be measured, how the project team will decide on these measures (e.g., the research literature, community engagement, etc,) and the anticipated effects of the proposal on health equity. For some proposals, it may be appropriate to describe how affected communities have been involved in developing the research and will be engaged in making use of the research findings.
- Feasibility of Timeline. Projects must be feasible to be completed within one to two years.
- Awarded projects are expected to start January 8, 2024.
- After notice of award and as a condition of funding, PIs must submit a letter to LDI from Penn’s IRB indicating approval or exemption.
- All awardees will be required to submit brief reports about study’s progress.
- First Interim Report (Due: June 9, 2024)
- Additional Reports (Due: every six months)
- Investigators must acknowledge financial support from the LDI Research Initiative on Improving Management of Chronic Kidney Disease on all publications and other products of the program.
- Investigators may be asked to present their results at an Advisory Committee meeting, at a meeting with the Monogram Health executive leadership team, or at an LDI seminar.
How to Apply
LDI Senior Fellows should first complete the brief online form of intent and then the online application form, which includes:
- Project Abstract (not to exceed 250 words)
- Project Description (up to five pages, single-spaced, 11-point font minimum, 0.5-inch margins top, bottom, left, right for all pages) which contains the following sections and suggested size:
- Aims and Significance (one page)
- Research Plan and Methodology (four pages)
- Should include a detailed description of data to be used or how the data will be collected; how key variables will be measured or defined; and an analysis plan
- Project Budget
- Proposals must include an itemized budget of up to $350,000 across all budget periods.
- An accompanying budget justification should clearly describe and justify the specific items to be funded by the grant.
- The budget may include the time of an LDI-dedicated analyst with experience pulling data from LDI’s data store and warehouse (if relevant for your project). Please contact Traci Chupik for further details about this analyst’s cost structure.
- The budget may include project salaries and benefits (e.g., faculty or staff), consultant fees, data management, supplies, and other direct expenses. Budgets may not include travel to meetings to present work, equipment, or indirect costs
- Project Timeline and Milestones
- Milestones should be identified along a timeline of up to 18 months. Milestones should be well-described, quantifiable, and scientifically justified benchmarks at critical junctures. This section may also include alternative strategies should any component efforts fail to perform as expected.
- Principal Investigator’s Biosketch with selected relevant publications, current research support, and research support received during the past three years (follow current NIH biosketch guidelines).
- Other Pending or Funded Grant Proposals for the same or similar projects.
- Co-Investigators’ abbreviated Biosketch(es) with selected relevant publications (not to exceed two pages).
- Appendices, limited to essential information that is directly relevant to the proposal, such as a pilot survey form or an operational lead’s support letter.
Forms of Intent are due Friday, September 29 and Proposals are due Tuesday, October 31.