Grant: Foundation Grant

<html> <body> <p>Comorbidity is a key driver of health in chronic kidney disease (CKD), a major health problem. However, management of comorbidity in CKD patients reflects the objectives of multiple physicians focusing on different diseases, rather than those of patients. This leads to competing therapeutic goals, harmful polypharmacy, poor outcomes and low satisfaction with care. <b>My research program will close key knowledge gaps and transform the management of comorbidity in people with CKD to a &ldquo;patient-centered&rdquo; model that meets the needs of patients and their families.</b> <br> <br> Work will proceed in 3 linked phases. In <b>Phase 1</b>, I will use a unique administrative data source (N=4 million) to identify subgroups where the risks of clinical outcomes, treatment-related harms, and death with/without treatment (competing risks) are high. Results will prioritize work in <b>Phase 2</b>, which will assess the priorities and perceptions of patients, families, and providers about the benefits and harms of treatment &ndash; using focus groups and surveys in Canada, the UK and Australia. This phase will highlight scenarios where therapeutic conflicts and harms are frequent, patient preferences are variable and outcomes are poor. In <b>Phase 3</b>, I will use 3 tools to address the key issues identified in Phases 1 and 2: <u>decision aids</u> (helping patients to make treatment choices consistent with their preferences); <u>practice guidelines</u> (revising selected &ldquo;disease-centered&rdquo; recommendations for CKD care to make them patient-centered); and patient-centered <u>quality measures</u> (to assess the quality of CKD care). Finally, I will integrate findings from all 3 phases to design and evaluate a complex health system intervention to deliver patient-centered management of comorbidity in CKD &ndash; capitalizing on my proven expertise in implementing such interventions.<br> <br> I am a nephrologist and clinician-scientist. My 343 peer-reviewed papers have been highly cited (h-index 55; &gt;10,000 total citations) and have informed international guidelines and Alberta health policy. I have held nearly $7 million in CIHR funding as PI over the last 7 years and have an endowed research chair that protects my time to lead this program. I have a strong record of research leadership.<br> <br> My research program addresses the priorities of key international stakeholders, and uses an integrated knowledge translation strategy &ndash; linking clinicians, researchers, healthcare decision-makers and patients: from generating research questions to using the findings. To implement my findings, I will leverage my strong provincial, national and international linkages to clinical leaders, policy-makers, patient organizations and guideline producers.<br> <br> Outcomes will include improved patient experience, stronger engagement of patients and their families in CKD care, better adherence to appropriate treatments, better clinical outcomes, research findings that are relevant to patients, and perhaps more efficient use of healthcare funds. These benefits will lead to policy changes that permit the scale-up of our findings and improve health system performance. A strong training program will support highly qualified researchers with multidisciplinary skills in policy-relevant, patient-centered research &ndash; and will foster a culture of collaboration between researchers, patients and decision-makers.<br> <br> Results will inform the management of comorbidity/multimorbidity &ndash; a key challenge for all health systems -- in people with CKD and perhaps other chronic conditions.</p> </body> </html>