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Outreach program increases transplant referral rate in dialysis clinics
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An educational and outreach initiative boosted kidney transplant referrals and reduced racial disparities in such referrals in Georgia, the state with the lowest kidney transplantation rate and the highest proportion of African Americans with kidney failure, according to study published in the Journal of the American Society of Nephrology.
Read also: Improving the efficiency of the pre-kidney transplant evaluation process
With the goal of not only improving referral for transplantation but also reducing racial disparities, Rachel Patzer, PhD, MPH, from Emory University School of Medicine, and her colleagues conducted the Reducing Disparities in Access to Kidney Transplantation (RaDIANT) Community Study, a randomized, dialysis facility–based, controlled trial involving ˃9000 patients receiving dialysis from 134 dialysis facilities in Georgia.
During the study, dialysis facilities with either low transplant referral or racial disparities in referral participated in transplant education and engagement activities targeting dialysis facility leadership, staff, and patients. For example, one intervention activity involved the non-profit organization Georgia Transplant Foundation that helped place patients who had previously received a transplant to go to a dialysis facility and talk with patients about their experience. Another intervention activity included educational webinars about transplantation for clinical staff, including information about the common barriers that patients may face and solutions for overcoming these barriers.
Compared with control facilities, facilities that adopted such activities had an increased likelihood of referring patients for kidney transplant evaluation over the following year. “We also found that intervention activities were more effective in getting African American patients referred for transplant compared with whites,” said Patzer. “This resulted in a significant reduction in racial disparities in referral for transplantation.”
Read also: Racial disparities in kidney transplant outcomes are narrowing
In the intervention facilities, the proportion of African American kidney failure patients who were referred increased from 10% at baseline to 16% at 1 year, whereas referrals decreased from 11.8% to 10.0% in control facilities. Among white kidney failure patients, there was a small, non-significant increase in the average proportion of patients referred for transplantation (from 9.6% to 10.6%) in the intervention facilities vs. a drop from 7.8% to 7.0% in control facilities.
Disclosures: Dr. Pastan is a minority shareholder in Fresenius College Park Dialysis, College Park, GA. The authors acknowledge the assistance of the Southeastern Kidney Council, Inc., and the Centers for Medicare & Medicaid Services (CMS) in providing data which made this research possible. The Reducing Disparities in Access to kidNey Transplantation Community Study was funded in part by NIMHD award R24MD008077.
The article, entitled “A Randomized Trial to Reduce Disparities in Referral for Transplant Evaluation,” will appear online at http://www.jasn.asnjournals.org/ on October 13, 2016; doi: 10.1681/ASN.2016030320.