Multilevel Intervention to Improve Racial Equity in Access to Kidney Transplant
Document Type
Article
Abstract
BACKGROUND:
African Americans (AAs) have reduced access to kidney transplant (KTX). Our center undertook a multilevel quality improvement endeavor to address KTX access barriers, focused on vulnerable populations. This program included dialysis center patient/staff education, embedding telehealth services across South Carolina, partnering with community providers to facilitate testing/procedures, and increased use of high-risk donors.
STUDY DESIGN:
This was a time series analysis from 2017 to 2021 using autoregression to assess trends in equitable access to KTX for AAs. Equity was measured using a modified version of the Kidney Transplant Equity Index (KTEI), defined as the proportion of AAs in South Carolina with end-stage kidney disease (ESKD) vs the proportion of AAs initiating evaluation, completing evaluation, waitlisting, and undergoing KTX. A KTEI of 1.00 is considered complete equity; a KTEI of < 1.00 is indicative of disparity.
RESULTS:
From January 2017 to September 2021, 11,487 ESKD patients (64.7% AA) were referred, 6,748 initiated an evaluation (62.8% AA), 4,109 completed evaluation (59.7% AA), 2,762 were waitlisted (60.0% AA), and 1,229 underwent KTX (55.3% AA). The KTEI for KTX demonstrated significant improvements in equity. The KTEI for initiated evaluations was 0.89 in 2017, improving to 1.00 in 2021 (p = 0.0045). Completed evaluation KTEI improved from 0.85 to 0.95 (p = 0.0230), while waitlist addition KTEI improved from 0.83 to 0.96 (p = 0.0072). The KTEI for KTX also improved from 0.76 to 0.91, which did not reach statistical significance (p = 0.0657).
CONCLUSIONS:
A multilevel intervention focused on improving access to vulnerable populations was significantly associated with reduced disparities for AAs.
Digital Object Identifier (DOI)
Publication Info
Published in Journal of the American College of Surgeons, Volume 236, Issue 4, 2023, pages 721-727.
APA Citation
Taber, D. J., Su, Z., Mulugeta Gebregziabher, Mauldin, P. D., Morinelli, T. A., Mahmood, A. O., Magwood, G. S., Casey, M. J., Scalea, J. R., Kavarana, S. M., Baliga, P. K., Rodrigue, J. R., & DuBay, D. A. (2023). Multilevel Intervention to Improve Racial Equity in Access to Kidney Transplant. Journal of the American College of Surgeons, 236(4), 721–727.https://doi.org/10.1097/XCS.0000000000000542
Rights
© 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.