Liver Transplant; Complications
Conditions
Keywords
Health Advocate, Patient Navigator
Brief summary
The Health Advocate for Liver Transplant (HEAL-Tx) Transition of Care Pilot is a nonrandomized, open-label intervention pilot of a health advocate intervention aimed to assess feasibility and acceptability of integrating a Health Advocate onto the transplant team to help adolescents transition their care to adult transplant teams. Across studies, health advocate roles vary, and can include coordinating medical care treatment, facilitating financial assistance (e.g., taxi vouchers), and connecting patients to community resources, which can improve self-management, mitigate social risks, and lead to better communication between the healthcare system and the family. In this pilot, the investigators will adapt this intervention for adolescent/young adult liver transplant patients and measure acceptability and feasibility according to RE-AIM.
Interventions
BEHAVIORALHealth Advocate
The Health Advocate intervention will include helping pediatric liver transplant recipients and their families address unmet household social needs (e.g., food insecurity), improve patient-provider communication, and enhance care coordination.
Sponsors
University of California, San Francisco
American Society of Transplantation
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 25 Years
Healthy volunteers
No
Inclusion criteria
1. Patient has received a liver transplant \>1 year ago 2. Study team has screened patient and discussed with the primary transplant practitioner that patient may benefit from the Health Advocate program. 3. Patient has an unmet social risk (e.g., food insecurity) or MLVI \>/= 2.0. 4. Patient will be transferred to adult transplant team in \<6 months. 5. Patient can read and write English or Spanish 6. Patient is between 18-25 years old and can provide informed consent. 7. Patient has a working phone and smart device capable of video and/or audio virtual visits via Zoom.
Exclusion criteria
* Patient has significant cognitive impairment. * Does not meet age criteria * Patient is a ward of the state. * Non-English, non-Spanish speakers. * Non-US residents.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in patient experience | Baseline and 180 days | The investigators will administer a survey of patient experience at study enrollment and at the end of the intervention to assess for changes in patient experience with the transplant team. These questions will focus on experiences receiving transplant care, experiences discussing social needs with the transplant team, and overall subjective assessment of the transplant recipient's overall health. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in medication adherence using MLVI | Baseline and 180 days | Medication level variability index (MLVI) defined as the standard deviation of at least 3 outpatient tacrolimus trough levels (binary \>/=2.0 or \<2.0). The investigators will assess this at study entry and again at 180 days. |
| The quality of health advocate interactions with the participants, healthcare team, and community-based resources. | 180 days | The Health Advocate will keep a detailed journal entry after each encounter and certain Health Advocate interactions will be recorded. The investigators will qualitatively analyze these journal entries and recordings to identify what functions the health advocate undertook. |
| A qualitative assessment of patient and healthcare provider satisfaction with the Health Advocate intervention. | 180 days | The investigators will conduct in-depth interviews with the patient participant and clinical team members to assess overall satisfaction with the intervention. |
Countries
United States
Contacts
CONTACTSharad Wadhwani, MD, MPH
PRINCIPAL_INVESTIGATORSharad Wadhwani, MD, MPH
University of California, San Francisco
Outcome results
None listed