# Technology Assisted stepped Collaborative Care Intervention to Improve Patient-centered Outcomes in Hemodialysis

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2021 · $95,049

## Abstract

Majority of the end-stage renal disease (ESRD) patients on hemodialysis (HD) experience a substantial
symptom burden, which significantly impairs their health-related quality of life (HRQOL). Additionally, patient
symptoms of depression, pain and fatigue are associated with increased hospitalization and mortality,
potentially mediated by behavioral factors such as non-adherence to medication and dialysis, as well as
biological factors such as inflammatory cytokines. Given the limited effectiveness of prior interventions to
alleviate symptoms and improve HRQOL in HD patients, and lack of evidence on their effect on bio-behavioral
mediators, our proposed study fulfills a critical need for providing patient-centered dialysis care, while
advancing mechanistic insights into the underlying inflammatory process. Our team has successfully
demonstrated the effectiveness of a stepped collaborative care intervention (SCCI) in other chronically ill
patient populations. Collaborative care provides an integrated multi-disciplinary structured management plan;
and a stepped approach for pharmaco- and/or behavioral-therapy allows for individualization of treatment
according to patients' clinical status, preferences and treatment response. In order to simplify the delivery of
the behavioral therapy component of SCCI and reduce the associated patient and provider burdens, our multi-
disciplinary team of experts in nephrology, psychology, and health technology pioneered and tested the
delivery of behavioral therapy using video-conferencing in dialysis units. Our pilot study showed that this
approach is feasible, acceptable and requires minimal additional resources. The goal of the proposed
Technology Assisted Stepped Collaborative Care Intervention (TASCCI) study is to test the effectiveness of
SCCI for alleviating symptom clusters and improving HRQOL in a multi-center randomized controlled trial of
160 diverse HD patients from Pennsylvania and New Mexico. We will compare the effectiveness of our
intervention with an attention control arm of technology-delivered health education to improve key patient-
centered outcomes. Specifically, we will examine 1) changes in depression (primary outcome), pain, fatigue
and HRQOL after 12 week intervention (Aim 1), 2) effect on medication and dialysis adherence (Aim 2); and 3)
changes in levels of inflammatory biomarkers (Aim 3). This study directly responds to call from Kidney Disease
Improving Global Outcomes (KDIGO) for integration of symptom assessment and management in routine
ESRD care. TASCCI may provide a feasible and resourceful approach to alleviate common patient symptoms
and improve HRQOL for HD patients that could be readily adopted and integrated in routine dialysis care for
wide-scale dissemination.

## Key facts

- **NIH application ID:** 10331180
- **Project number:** 3R01DK114085-05S1
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Manisha Jhamb
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $95,049
- **Award type:** 3
- **Project period:** 2017-07-05 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10331180

## Citation

> US National Institutes of Health, RePORTER application 10331180, Technology Assisted stepped Collaborative Care Intervention to Improve Patient-centered Outcomes in Hemodialysis (3R01DK114085-05S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10331180. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*