# Multilevel Intervention Strategies to Transform Kidney Care and Improve Pursuit of Transplant in an Integrated Healthcare Delivery System

> **NIH AHRQ R01** · METHODIST HOSPITAL RESEARCH INSTITUTE · 2022 · $399,999

## Abstract

PROJECT SUMMARY
Approximately 15% of the U.S. population has chronic kidney disease, and ~700,000 patients are in full kidney
failure also called end-stage kidney disease (ESKD). The optimal treatment for ESKD is living donor kidney
transplantation (LDKT), followed by deceased donor kidney transplantation (DDKT); however, the standard of
care continues to be ongoing dialysis, which has poor clinical outcomes in comparison to LDKT and DDKT. Best
practices to transform kidney care recommended by the Centers for Medicare and Medicaid Services (CMS),
the American Society of Nephrology (ASN) and the 2019 Executive Order Advancing American Kidney Health
Initiative include earlier detection of patients whose kidneys are deteriorating rapidly, introducing transplant as a
potential treatment option earlier, optimally before their kidneys fail, improved dissemination of health literate
transplant education tools, often through digital technology or mHealth, and increasing LDKT rates by helping
patients locate living donors or motivating others to donate. Barriers at the patient-, support network-, clinician-
and system-levels of the Socio-Ecological Model persist, including poor identification of high-risk patients,
insufficient clinician time to discuss transplant, poor transplant knowledge, reluctance or insufficient support to
ask living donors to donate, and disengaged friends and relatives, some of whom who might become living
donors. While extensive policy and intervention efforts are underway, none have achieved significant increases
in pursuit and receipt of transplant, especially LDKT rates. In 2017, Kaiser Permanente Southern California
(KPSC), an integrated care system serving 24,000 CKD patients, partnered with the Transplant Research and
Education Center (TREC) at Houston Methodist Research Institute (HMRI) and J.C. Walter Jr. Transplant Center
Houston Methodist Hospital (HMH) to launch a multi-year plan for transforming CKD and ESKD care. We now
propose to conduct a pragmatic stepped wedge cluster randomized trial of a novel multilevel intervention to
improve CKD and ESKD care, improve transplant rates and reduce disparities. One innovative component of
the multilevel intervention is a state-of-the-art technology-supported Grove Kidney Health mHealth application,
developed in partnership with patients, to engage patients, family members, and potential living donors to
improve their CKD knowledge, view transplant success stories, and seek kidney-related support to pursue
transplant, including learning how to find living donors. We also seek to identify moderators at various socio-
ecological levels, especially factors influencing variations in effectiveness across different settings and among
underserved patient subgroups known to have reduced access to transplant and build implementation tools to
increase access to and pursuit of transplant within large integrated health systems including comparable systems
(commercial, academic, safety net) ...

## Key facts

- **NIH application ID:** 10521483
- **Project number:** 1R01HS028655-01A1
- **Recipient organization:** METHODIST HOSPITAL RESEARCH INSTITUTE
- **Principal Investigator:** BRIAN S MITTMAN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $399,999
- **Award type:** 1
- **Project period:** 2022-08-15 → 2027-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10521483

## Citation

> US National Institutes of Health, RePORTER application 10521483, Multilevel Intervention Strategies to Transform Kidney Care and Improve Pursuit of Transplant in an Integrated Healthcare Delivery System (1R01HS028655-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10521483. Licensed CC0.

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