Assessing Transplant Education Practices in Dialysis Centers

Abstract

Background and objectives The Centers for Medicare & Medicaid Services (CMS) requires that dialysis centers inform new patients of their transplant options and document compliance using the CMS-2728 Medical Evidence Form (Form-2728). This study compared reports of transplant education for new dialysis patients reported to CMS with descriptions from transplant educators (predominantly dialysis nurses and social workers) of their centers' quantity of and specific educational practices. The goal was to determine what specific transplant education occurred and whether provision of transplant education was associated with center-level variation in transplant wait-listing rates.Design, setting, participants, & measurements Form-2728 data were drawn for 1558 incident dialysis patients at 170 centers in the Heartland Kidney Network (Iowa, Kansas, Missouri, and Nebraska) in 2009-2011; educators at these centers completed a survey describing their transplant educational practices. Educators' own survey responses were compared with Form-2728 reports for patients at each corresponding center. The association of quantity of transplant education practices used with wait-listing rates across dialysis centers was examined using multivariable negative binomial regression.Results According to Form-2728, 77% of patients (n=1203) were informed of their transplant options within 45 days. Educators, who reported low levels of transplant knowledge themselves (six of 12 questions answered correctly), most commonly reported giving oral recommendations to begin transplant evaluation (988 informed patients educated, 81% of centers) and referrals to external transplant education programs (959 informed patients educated, 81% of centers). Only 18% reported having detailed discussions about transplant with their patients. Compared with others, centers that used more than three educational activities (incident rate ratio, 1.36; 95% confidence interval, 1.07 to 1.73) had higher transplant wait-listing rates.Conclusions While most educators inform new patients that transplant is an option, dialysis centers with higher wait-listing rates use multiple transplant education strategies.

Awareness of the New Kidney Allocation System among United States Dialysis Providers with Low Waitlisting

“…Results are consistent with other studies that have documented limited transplant knowledge among dialysis staff [5]. Fewer than 20% of dialysis staff report having detailed discussions about transplantation with their patients [5], and black patients are less likely to be educated about transplant as a treatment option [6]. In turn, limited staff knowledge about transplantation is associated with decreased patient access to transplantation [7], suggesting that staff education, and particularly culturally sensitive interventions, may be needed.…”

“…This suggests that, while knowledge of transplantation and KAS is high among medical directors, it may not be disseminated to the other staff who may serve as transplant educators within the facility. Results are consistent with other studies that have documented limited transplant knowledge among dialysis staff [5]. Fewer than 20% of dialysis staff report having detailed discussions about transplantation with their patients [5], and black patients are less likely to be educated about transplant as a treatment option [6].…”

Cultural competency of a mobile, customized patient education tool for improving potential kidney transplant recipients’ knowledge and decision-making

“…The MTC app resulted in statistically and clinically significant increases in patient knowledge The need for effective educational interventions in patients with ESRD is crucial as patients must choose between dramatically different renal replacement therapy options, especially given the ongoing and profound disparities in access to transplantation [22][23][24][25]. Patients with reduced access to specialty care and health information (e.g.…”

Using Patient-Reported Measures in Dialysis Clinics

“…The importance of providing information about transplants to patients is evidenced by the fact that it increases the likelihood that they will pursue and receive transplants (11). For this reason, the CMS's 2008 Conditions for Coverage for dialysis facilities require that information about the option for kidney transplant be provided to each patient on dialysis.…”