Intensive Patient Referral and Education Program Prior to Renal Replacement Therapy

The Intensive Patient Referral and Education Program prior to Renal Replacement Therapy (iPREP-RRT) will determine the efficacy of the hospital-based patient intervention (HPI) in improving patient knowledge, self-efficacy, and intent for chronic kidney disease (CKD) self-management and renal replacement therapy (RRT) planning; and 2) determine the efficacy of the community-based patient intervention (CPI) during a 12 week outpatient follow-up program that combines outpatient follow-up with multiple modes of communication (in-person session, phone calls and personalized text messaging) and navigation in increasing participants' initiation and maintenance of CKD self-management and RRT planning, compared to enhanced usual care (attention controls).

The goal is to improve knowledge and outcomes for African American patients with advanced CKD through the iPREP-RRT. To accomplish this goal, investigators will 1) determine the efficacy of the hospital-based patient intervention (HPI) in improving participant knowledge, self-efficacy, and intent for CKD self-management and RRT planning; and 2) determine the efficacy of the community-based patient intervention (CPI) during a 12 week outpatient program that combines outpatient follow-up with multiple modes of communication (in-person session, phone calls and personalized text messaging) and navigation in increasing initiation and maintenance of CKD self-management and RRT planning, compared to enhanced usual care. To that end, investigators will conduct a one-site randomized controlled trial, where participants will be randomized in a 1:1 ratio into either the intervention (iPREP-RRT) or control groups (enhanced usual care). The randomization will be stratified by baseline blood pressure (controlled or uncontrolled). Participants will receive 2 in-person education sessions (during hospitalization and week 12), phone sessions at weeks 4 and 8, and weekly personalized text message contact. The duration of the intervention will be 12 weeks, and participants and controls will be assessed pre-intervention, immediately post-hospital based intervention, at 4 ,8 and 12 weeks during community-based intervention and 4 weeks post-intervention (16 weeks).

• In-Person Patient Education (Behavioral): In-person patient education about CKD, CKD risk factor management and renal replacement therapy options.
• Commitment to Change (Behavioral): Motivational interviewing to assist participants in committing to change in CKD management or RRT selection.
• Blood pressure monitoring (Behavioral): Participants will learn how to check their blood pressure and will receive a blood pressure cuff for home.
• Written Patient Education (Behavioral): Written patient education booklet about general health care management including taking medications, having a primary care doctor, weight management and exercise.
• Text-based reinforcement for CKD self-management (Behavioral): Patient educator will use text messages based on social cognitive theory to remind participants about and reinforce goals set around CKD self-management, blood pressure control and RRT selection
• Community-based education session, reinforcement for self-management (Behavioral): Patient educator will use provide a "booster" session based on social cognitive theory to remind participants about and reinforce goals set around CKD self-management, blood pressure control and RRT selection
• Text-based reinforcement for general health self-management (Behavioral): Patient educator will use text messages to send general health management messages

Primary outcomes

• Kidney Disease Knowledge Questionnaire (KIKS) [Baseline, 1 day Post Brief Intervention, Week 4, Week 12, Week 16]: The Kidney Disease Knowledge Questionnaire (KIKS) is a validated instrument that assesses CKD knowledge. Scores range from 0 (no knowledge)-28 (full knowledge). Change =Post intervention-Baseline scores, and Follow-up (Week 4, Week 12, Week 16)-Baseline
• ESRD Knowledge [Baseline, 1 day Post Brief Intervention, Week 4, Week 12, Week 16]: The Kidney Failure Treatment Knowledge is an investigator developed tool that assesses knowledge of 6 ESKD treatment options using a Likert scale (0=no knowledge and 4=a great deal of knowledge). Possible scores range from 0-24. Change =Post intervention-Baseline scores, and Follow-up (Week 4, Week 12, Week 16)-Baseline
• Blood Pressure Knowledge [Baseline, 1 day Post Brief Intervention, Week 4, Week 12, Week 16]: Blood Pressure Knowledge Scale (BPKS, revised) is an 11-item scale; a summed score is computed. Scores range from 7 to 77 and higher scores indicate greater knowledge. Change =Post intervention-Baseline scores, and Follow-up (Week 4, Week 12, Week 16)-Baseline
• CKD Self-Management [Baseline, Week 8, Week 12, Week 16]: The CKD Self-Management Knowledge Toolkit (CKD-SMKT) is a validated 10 item survey to assess participants CKD self-management behaviors. The survey consists of 2 true /false questions for each of the 10 self-care domains and can be scored from 0 (no self-care) to 20 (full self-care). Change is Follow-up Score (Week 8, Week 12, Week 16)-Baseline

Secondary outcomes

• CKD Self-Efficacy [Baseline, 1 day Post Brief Intervention, Week 4, Week 8, Week 12, Week 16]: CKD Self-Efficacy Scale (CKD-SE), 25-item CKD-SE instrument can be used for the early identification of patients with low self-efficacy. The scale is from 0 to 10 points, and a larger number indicates a higher level of confidence regarding the management activity. The total score on the scale ranges between 25 and 250. The total score can be classified into three categories: low self-efficacy (score less than 30), moderate (scores between 30 to 70), and high self-efficacy (score more than 70). Change is Follow-up Score (Week 8, Week 12, Week 16)-Baseline
• CKD Health Intent [Baseline, 1 day Post-Brief Intervention, Week 4]: The Health Intent Survey is an investigator-developed tool to measure participants stated intent to make healthy lifestyle changes. There are 12 questions each scored on a 5 point scale from 1=extremely unlikely to 5=extremely likely (60 total possible points with higher scores better). Change=Follow-up (1 day post-intervention, Wk4, wk 8, wk 12, wk16) - baseline.

Sex: All, ages: 18 Years to 70 Years

Inclusion Criteria:

* Patients over the age of 18 and under 70
* Admitted to the University of Chicago inpatient general medicine service
* Likely hospital stay greater than 48 hours
* Diagnosis of advanced CKD (Stage 3B or above, as determine by problem list, ICD- 10 codes or eGFR<45 during admission and from previous medical encounters)
* Self-identify as Black or African American

Exclusion Criteria:

* Non-English speaking
* Unable to communicate due to current medical status
* Unable to consent due to mental status
* Expected hospital stay less than 24 hour
* Current admission in ICU

NIH grants: R01DK124597