# Technology Assisted Stepped collaborative Care Intervention (TASCCI) to Improve Patient-centered Outcomes in Hemodialysis Patients

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2020 · $657,233

## 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 150 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:** 9952365
- **Project number:** 5R01DK114085-04
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Manisha Jhamb
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $657,233
- **Award type:** 5
- **Project period:** 2017-07-05 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9952365

## Citation

> US National Institutes of Health, RePORTER application 9952365, Technology Assisted Stepped collaborative Care Intervention (TASCCI) to Improve Patient-centered Outcomes in Hemodialysis Patients (5R01DK114085-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9952365. Licensed CC0.

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