Actively Recruiting
Community Health Workers in an Interdisciplinary Outpatient CKD Clinic to Optimize Social Care Navigation, Patient Engagement, and Home Dialysis Utilization
Led by Montefiore Medical Center · Updated on 2026-04-15
106
Participants Needed
1
Research Sites
124 weeks
Total Duration
On this page
Sponsors
M
Montefiore Medical Center
Lead Sponsor
N
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Collaborating Sponsor
AI-Summary
What this Trial Is About
The goal of this clinical trial is to learn if this intervention (the CHOOSE Home intervention) is feasible and may lead to more home dialysis usage in a high-risk patient population. The main questions it aims to answer are: * Will there be an increase in home dialysis selection or initiation over study follow up? * Will there be a change in patient reported status of Health-Related Social Needs (HRSNs) and patient engagement at 1 year follow up? Researchers will compare the intervention group that will include interdisciplinary care (IDC) and the integration of a Community Health Worker (CHW) into the chronic kidney disease (CKD) care process to the IDC only control group. The research team will assess whether the intervention led to better social care navigation, enhanced patient engagement, and increased home dialysis use.
CONDITIONS
Official Title
Community Health Workers in an Interdisciplinary Outpatient CKD Clinic to Optimize Social Care Navigation, Patient Engagement, and Home Dialysis Utilization
Who Can Participate
Eligibility Criteria
You may qualify if you...
- Age �3e= 18 years
- Advanced CKD with eGFR of 25 ml/min/1.73m2 or less using the 2021 CKD-EPI equation
- English or Spanish speaking
- Provide informed consent
- Followed by a nephrologist at Montefiore and seen within the last 12 months
- Willing to receive interdisciplinary care including nurse practitioner-facilitated CKD education and care coordination
You will not qualify if you...
- Active malignancy
- Anticipated survival less than 1 year as determined by treating nephrologist
- Choosing medical management only (non-dialysis supportive care) for kidney failure
- Planning to relocate outside of New York City within the next 12 months
AI-Screening
AI-Powered Screening
Complete this quick 3-step screening to check your eligibility
Trial Site Locations
Total: 1 location
1
Albert Einstein College of Medicine
The Bronx, New York, United States, 10461
Actively Recruiting
Research Team
Y
Yaxkyn A Mejia, BS
CONTACT
How is the study designed?
Study Type
INTERVENTIONAL
Masking
SINGLE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
HEALTH_SERVICES_RESEARCH
Number of Arms
2
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