# Technology Assisted Collaborative Care Implementation Trial

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2024 · $694,969

## Abstract

Abstract
End-stage kidney disease patients on in-center hemodialysis (HD) experience a substantial symptom burden,
which is associated with poor health-related quality of life (HRQOL), hospitalizations and mortality. Fatigue,
pain and depression are among the most debilitating symptoms, reported by more than 60%, 50% and 20%
of patients, respectively. Despite the significant prevalence and impact of these symptoms, treatment options
remain limited. The management of symptoms has been identified as a high research priority advocated by
patient advocacy groups and in both the National Institute of Health's scientific workshop and Kidney Disease
Improving Global Outcomes conferences. Recently, we successfully completed a randomized controlled trial,
Technology Assisted Stepped Collaborative Care (TĀCcare), to test an intervention to improve symptom
burden among 160 diverse patients on HD from Western Pennsylvania and New Mexico. Our intervention
had unique strengths that included targeting symptom cluster (fatigue, pain and depression), a shared
decision-making approach for pharmaco- and/or cognitive behavioral-therapy (CBT), stepped approach for
treatment, telemedicine delivered CBT in dialysis units, and a collaborative care model that integrated
symptom management with patients' dialysis and primary care teams. Our results showed clinically significant
improvements in fatigue and pain, and small improvement in depression, after a 12-week intervention that
were sustained for 6 months, as compared to an attention control arm. The goal of this proposal is to
conduct a hybrid Type II effectiveness-implementation, cluster randomized trial of TĀCcare 2.0 facilitated by
dialysis staff in a real-world setting. The TĀCcare 2.0 intervention will build on successful design elements of
the original intervention, enhance depression management strategies and increase durability of effect by
incorporating monthly longitudinal telemedicine-delivered booster sessions to complete a total 12-month
intervention. This proposal leverages our team's experience, collaboration, unique institutional resources, and
stakeholder advisory board (dialysis unit leadership, staff and patients) input, and will recruit 424 diverse
patients from 36 dialysis units (diverse in academic affiliation, rural/urban location) in Pennsylvania, New
Mexico, Tennessee, Alabama, Nebraska and New Jersey. We aim to 1) evaluate effectiveness of TĀCcare
2.0 in reducing fatigue, pain or depression (co-primary outcomes) after 12-week intervention compared to
usual care in HD patients (Aim 1); and 2) examine implementation barriers and facilitators at patient, provider
and organizational levels using Practical Implementation Sustainability Model (PRISM) based mixed-methods
(Aim 2). If successful, this study will provide transformative evidence and a blueprint to dialysis clinics and
policy makers for an integrated, scalable intervention and a set of implementation strategies and facilitation
toolkit t...

## Key facts

- **NIH application ID:** 10981741
- **Project number:** 2R01DK114085-06
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Manisha Jhamb
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $694,969
- **Award type:** 2
- **Project period:** 2017-07-05 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10981741

## Citation

> US National Institutes of Health, RePORTER application 10981741, Technology Assisted Collaborative Care Implementation Trial (2R01DK114085-06). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10981741. Licensed CC0.

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