The University of Pennsylvania’s Leonard Davis Institute of Health Economics (LDI) has announced the final two grants awarded as part of its Research Initiative on Improving Management of Chronic Kidney Disease (CKD). The projects are designed to advance the U.S. health care system’s capacity to effectively identify, manage, and improve the care received by patients with CKD and end-stage kidney disease. The projects are:

Using Community Health Workers and Trauma-informed Care Training for Clinicians to Improve Kidney Disease Outcomes in a Diverse Urban Community

Principal Investigators: Judith Long, MD | Perelman School of Medicine and Meera Harhay, MD, MPH | Drexel University College of Medicine

Judith Long, MD and Meera Harhay, MD, MPH

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

A Pilot Randomized Trial of a Produce Prescription Intervention to Improve Health among Food-insecure Adults with Chronic Kidney Disease

Principal Investigator: Eliza Kinsey, PhD, MPH | Perelman School of Medicine

Eliza Kinsey, PhD, MPH

An estimated 25% of persons with CKD in the U.S. are food insecure, and they are 38% more likely to develop end stage kidney disease than food secure individuals with CKD. Evidence-based treatment to prevent CKD progression includes following a healthy diet rich in fruits and vegetables. However, patients with CKD report difficulty adhering to healthy dietary guidance because of the high cost of healthy foods. This study will use a randomized controlled trial (n=100) to examine the feasibility, acceptability, and likely effect of a produce prescription intervention on patient-centered outcomes, health behaviors and health outcomes among food insecure adults with CKD stages 3-5. Participants in the intervention group will receive produce prescription vouchers redeemable at participating retailers for fresh fruits and vegetables. All study participants will be followed for changes to diet quality, food security, quality of life, and clinical outcomes. Uptake of the intervention will be identified using monthly surveys and intervention redemption rates, as well as surveys with eligible individuals who decline enrollment, while acceptability will be assessed through in-depth qualitative in- terviews with study participants. Broader feedback from the community will be gathered through a community advisory board. Produce prescription programs have shown improved outcomes for people with other chronic conditions, but little research has examined their efficacy or feasibility in populations with kidney disease. The establishment of effective interventions to reduce food insecurity in the CKD population will enable advancements in uptake of evidence-based dietary treatment to prevent disease progression, improvement of health outcomes, and reductions in health disparities.