Multilevel interventions increased access to kidney transplants for African Americans
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Multilevel interventions, such as standardizing the evaluation process, utilizing telehealth improved access to kidney transplantation for African Americans, according to data published in the Journal of the American College of Surgeons.
“Interventions to reduce structural barriers in access to transplants significantly increase the proportion of African Americans that can complete a transplant evaluation, be added to the transplant waitlist and eventually receive a transplant,” Derek A. DuBay, MD, MSPH, lead author and a transplant surgeon at the Medical University of South Carolina (MUSC) in Charleston, said in the press release.
In a retrospective analysis from 2017 to 2021, researchers examined data for 11,487 patients (64.7% were African American) with end-stage kidney disease who were referred for a kidney transplant to MUSC. They sought to determine the impact of interventions implemented at MUSC on racial disparities in kidney transplant access.
Interventions included educating dialysis staff and patients, embedding telehealth services across South Carolina, partnering with community providers to conduct testing and procedures, and using more high-risk donors.
Researchers utilized autoregression to measure trends in equitable access to kidney transplantation for African Americans between 2017 and 2021. Using a modified version of the Kidney Transplant Equity Index (KTEI), researchers assessed equity, which was defined as the proportion of African Americans in South Carolina with ESKD vs. the proportion of African Americans starting evaluation, completing evaluation, put on the waitlist and receiving a transplantation.
Using this index, a KTEI of 1 is full equity and KTEI less than 1 implies a disparity.
Ultimately, 6,748 patients initiated an evaluation (62.8% were African American); 4,109 completed evaluation (59.7% were African American); 2,762 were wait-listed (60% were African American) and 1,229 received a transplantation (55.3% were African American).
In 2017, the KTEI for initiated evaluations was 0.89 and it increased to 1 in 2021. Similarly, the KTEI for completed evaluations increased from 0.85 to 0.95, and the KETI for waitlisted patients improved from 0.83 to 0.96. Although it did not reach statistical significance, the KTEI for kidney transplantation increased from 0.76 to 0.91.
According to the press release, “ virtual visits probably had the most impact in reducing barriers to evaluation by reducing the need for patients and caregivers to take the time and expense to travel to in-office visits.”
Reference:
Disparities in kidney transplant access can be reduced through a multilevel quality improvement effort. https://www.newswise.com/articles/disparities-in-kidney-transplant-access-can-be-reduced-through-a-multilevel-quality-improvement-effort/?ad2f=1&aid=785867. Published Jan. 26, 2023. Accessed Jan. 30, 2023.
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