Community Health Workers in an Interdisciplinary Outpatient CKD Clinic to Optimize Social Care Navigation, Patient Engagement, and Home Dialysis Utilization- the CHOOSE Home trial

PROJECT ABSTRACT Despite overrepresentation in the end-stage kidney disease (ESKD) population, African American/Black and Latinx/Hispanic patients are less likely to have optimal transitions to ESKD care including lower rates of a modality associated with better clinical and quality of life benefits: home dialysis. Social risk factors are major contributors to disparities in home dialysis utilization. Black and Hispanic patients are more likely to be unaware of home dialysis options due to inadequate pre-ESKD care, have lower patient engagement, and have other health-related social needs (such as housing insecurity or instability, transportation barriers, food insecurity, limited social support, and financial toxicity), which can influence home dialysis acceptance and receipt. Thus, interventions to address racial and ethnic disparities will require a multipronged approach to address both care delivery and social risk factors that undermine home dialysis uptake. Our preliminary work in a predominantly Black and Hispanic population showed the benefits of an interdisciplinary care (IDC) chronic kidney disease (CKD) clinic, which included nurse practitioner education and care coordination, to improve care delivery. We propose a multifaceted intervention that will include IDC and integration of a Community Health Worker (CHW) into the CKD care process to optimize social care navigation, enhance patient engagement, and increase home dialysis use. To evaluate the intervention, we will conduct a pilot, pragmatic, randomized, parallel arm trial, the CHOOSE Home Trial: Community Health Workers in an Interdisciplinary Outpatient CKD Clinic to Optimize Social Care Navigation, Patient Engagement, and Home Dialysis Utilization. We will enroll 106 participants with advanced CKD from nephrology clinics in the Bronx, NY, a sample composed of predominantly Black and Hispanic patients. Participants will be randomized to the CHOOSE Home intervention (CHW + IDC) vs. control (IDC alone). Our study aims are to: 1) utilize a community- engaged approach with input from diverse community partners to refine the CHOOSE Home Trial; and 2) evaluate the feasibility, acceptability, and possible effect of the CHOOSE Home Intervention. Feasibility and acceptability will be evaluated using complementary quantitative and qualitative measures and organized into the dimensions of the RE-AIM framework. We hypothesize that the CHOOSE Home intervention is feasible and may lead to increased home dialysis utilization by more effectively addressing health-related social needs and fostering greater patient engagement. This proposal brings together experts in CKD care, SDOH, health equity, implementation and community-engaged research. The results will be used to inform further studies in CKD care delivery to reduce health inequities in home dialysis use and improve the quality of life for patients with CKD.