Disparities in National Kidney Allocation Policy (ASCENT)

National Institutes of Health (NIH), National Institute on Minority Health and Health Disparities (NIMHD)

The purpose of the current study is to test a systems-level approach to disseminate a multicomponent, multilevel intervention consisting of educational materials about transplantation and the new kidney allocation system targeting dialysis facility Medical Directors, staff, and patients. Roughly 750 dialysis facilities in up to 18 end stage renal disease Network regions across the United States will be randomized to receive intervention materials. The overall goal of the study is to extend the influence of the national allocation policy in reducing disparities in early steps in kidney transplant access.

The purpose of the ASCENT study is to test a systems-level approach to disseminate a multi-component intervention consisting of in the era of the new national kidney allocation policy and educational materials targeting dialysis facility Medical Directors, staff, and patients. The investigators will randomize ~750 dialysis facilities in up to 18 End Stage Renal Disease Network regions across the United States, where approximately half of facilities will receive the intervention materials and half will receive an informational brochure. This pragmatic, clinical effectiveness-implementation study will test the effectiveness of the multicomponent, multilevel interventions consisting of a tailored, facility-specific transplant and disparity performance report, educational videos for staff and dialysis patients, and an educational webinar for dialysis facility Medical Directors and staff.

End Stage Renal Disease (ESRD) facilities will receive feedback reports containing facility specific data, an educational webinar for dialysis facility medical directors and staff, and an educational video for patients and staff.

End Stage Renal Disease (ESRD) facilities will conduct usual care and receive United Network for Organ Sharing (UNOS) educational pamphlets for staff.

Medical directors will be provided performance feedback reports that are a summary of clinical performance of transplant and racial disparity performance over a period of time aimed at providing information to allow them to assess and adjust their transplant performance. The report will emphasize tailored facility-specific information on the mean time on dialysis for patients in that facility and transplant access performance measures, such as wait listing and transplantation, including the magnitude of racial disparity, detailing when a facility is performing below the national or regional average.

Dialysis facility staff will watch a ~10 minute educational video that describes the role of dialysis staff in improving transplant access, the new kidney allocation policy, and how the new policy impacts minority patients and those on dialysis for a substantial period of time.

Dialysis facilities will receive a ~10 minute educational video targeted to dialysis patients to explain the transplant process and allocation policy.

Education for medical directors and facility staff about the kidney allocation policy will be discussed in a webinar and information will be hosted on a website for participants to access. The seminar will be roughly 45 minutes, and CME will be offered.

Dialysis facility staff will be provided an educational pamphlet detailing the changes in the new kidney allocation policy .

The proportion of African Americans versus Caucasians wait listed at baseline and up to one year post-intervention.

Knowledge about the kidney allocation system was assessed using a survey among medical directors. The survey was used to quantify provider knowledge of Kidney Allocation System (KAS) and transplantation using a cumulative knowledge score ranging from 0 to 5 (0=least knowledge, 5=highest level of knowledge). A higher score is a better outcome.

Percentage of Staff Training About Kidney Transplant and the Allocation System at Baseline and Post-intervention

Staff training about kidney transplant and the allocation system was assessed using a survey among medical directors. Providers were asked what percentage of staff they think have been trained and staff training score was based on facility-level average percent. Scores range from 0 to 5 with a higher score being a better outcome. Score scale: 0 = 0%, 1=1-20%, 2=21-40%, 3=41-60%, 4=61-80%, 5=81-100%

Patient education about kidney transplant will be assessed using a survey among medical directors. Providers were asked what percentage of patients they think have received transplant education and score was based on facility-level average percent. Scores range from 0 to 5 with a higher score being a better outcome. Score scale: 0 = 0%, 1=1-20%, 2=21-40%, 3=41-60%, 4=61-80%, 5=81-100%.

Change in referral practices will be measured by surveying medical directors about the estimated proportion of patients interested,eligible, and referred for transplant in their facility. Scores were on a scale from 0 to 4 with a lower score being a better outcome. kas.ref.overall: 1=More, 2=Same, 3=Fewer, 4=Unsure

Inclusion Criteria: Dialysis facilities with at least 25 patients composed of at least 10% African American and 10% Caucasian Exclusion Criteria: Dialysis facilities with wait listing rates above the national tertile