MOBILIZE: Mobility & Transportation Solutions to Improve Hemodialysis Access

PROJECT SUMMARY 5.8 million individuals miss or delay medical care because of a lack of transportation. Persons with end stage kidney disease (ESKD) particularly depend on reliable transportation to dialysis sessions. In 2022, 84% of individuals newly diagnosed with ESKD initiated their treatment at an in-center hemodialysis (HD) facility, requiring they travel three times a week for HD. Yet 10% of patients with ESKD treated with HD miss dialysis at least monthly, and 35% miss treatment at least once every three months. Missing dialysis has significant individual and health system consequences, including increased emergency department visits, hospitalizations, and premature mortality and contributes to persistent racial and socioeconomic disparities in ESKD prevalence and outcomes. This Mentored Patient-Oriented Career Development Award (K23) will provide me with the training and mentorship needed to become an independent clinician-investigator and leader on transportation insecurity, social risk, and healthcare access for patients with ESKD. I am a family physician and medical anthropologist trained in qualitative and health services research and bring a unique perspective on how individual and community social context impacts healthcare. To achieve my long-term research and career goal of improving patients’ access to health care services and addressing longstanding health inequities, I need additional skills in (1) epidemiologic design and advanced quantitative analysis skills; (2) policy development and evaluation in transportation and ESKD, with emphasis on quality metrics; (3) clinical intervention development and implementation of future transportation solutions. I will accomplish the study’s goals through the following aims. Aim 1: Quantify social risk levels in a diverse group of patients with ESKD treated with in-center HD and associations with key HD outcomes in a prospective cohort study of 300 patients using the Accountable Health Communities (AHC) instrument. Aim 2: Assess the predictive validity of a novel transportation screening tool, the Transportation Security Index (TSI), in HD settings to identify patients most likely to miss HD appointments and compare its performance to the AHC’s transportation question. Aim 3: Identify facilitators and barriers to home dialysis as a component of addressing transportation insecurity in the ESKD population by conducting semi-structured interviews with patients, dialysis staff, and policy makers. The current proposal aligns with NIDDK’s priority area of developing interventions to integrate social and medical care to improve health equity and will break new ground by evaluating social risk within the ESKD population, with a focus on transportation insecurity.