Impact of a Patient Education Program on Disparities in Kidney Transplant Evaluation

Abstract

SummaryBackground and objectives In 2007, the Emory Transplant Center (ETC) kidney transplant program implemented a required educational session for ESRD patients referred for renal transplant evaluation to increase patient awareness and decrease loss to follow-up. The purpose of this study was to evaluate the association of the ETC education program on completion of the transplant evaluation process.Design, setting, participants, & measurements Incident, adult ESRD patients referred from 2005 to 2008 were included. Patient data were abstracted from medical records and linked with data from the United States Renal Data System. Evaluation completion was compared by pre-and posteducational intervention groups in binomial regression models accounting for temporal confounding.Results A total of 1126 adult ESRD patients were examined in two transplant evaluation eras (75% pre-and 25% postintervention). One-year evaluation completion was higher in the post-versus preintervention group (80.4% versus 44.7%, P,0.0001). In adjusted analyses controlling for time trends, the adjusted probability of evaluation completion at 1 year was higher among the intervention versus nonintervention group (risk ratio=1.38, 95% confidence interval=1.12-1.71). The effect of the intervention was stronger among black patients and those patients living in poor neighborhoods (likelihood ratio test for interaction, P,0.05).Conclusions Standardizing transplant education may help reduce some of the racial and socioeconomic disparities observed in kidney transplantation.

Modifiable Patient Characteristics and Racial Disparities in Evaluation Completion and Living Donor Transplant

“…Because previous research indicates that behavioral and educational interventions can improve patients' transplant knowledge and attitudinal willingness to pursue DDKT and LDKT (29), an important direction for future research is to test if these interventions also lead to more blacks completing evaluation and receiving LDKTs. Previous studies have indicated that educational interventions in different care settings can increase blacks' knowledge, willingness to pursue, and actual pursuit of DDKT and LDKT (15,29,30). This study also underlines the importance of educationally intervening early and before patients ever present for transplant, particularly in settings like community nephrologists' offices and dialysis centers.…”

“…Although a patient's health insurance is not modifiable by health care providers in transplant or dialysis centers, we recognize that policylevel interventions could influence the impact of these variables. Evidence presented in this paper and by others (11,13,15) that insurance type predicts evaluation completion should be taken under consideration by policymakers. Similarly, there are factors considered less modifiable in this study (for example, depression and anxiety) that actually could be modified for transplant patients with more comprehensive psychological interventions (46,47).…”

“…For example, less-modifiable patient characteristics, including being a man (10,12), being younger (9,10,(12)(13)(14), having higher levels of formal education (14,15), having better health insurance (11,(13)(14)(15), being employed (15), having a higher income (4,13), and having a primary care physician (11,16), have all been shown to be associated with completion of transplant evaluation and receipt of transplant. The majority of studies assessing patient characteristics associated with successful transplant outcomes rely on publicly available national databases like those databases from the Scientific Registry of Transplant Recipients (SRTR) or United States Renal Data System, which have limited measurement of more-modifiable patient characteristics.…”

Assessing Transplant Education Practices in Dialysis Centers

“…Future research must continue to examine whether these trends persist in a national sample of dialysis centers. However, one promising strategy for improving transplant education in centers with low-SES patients and those in rural areas farther away from transplant centers may be to provide educators with training about transplant's value for their patients; access to more patient-centered educational resources about transplantation; and resources, such as free transportation to a transplant center or more reimbursement for evaluation-related expenses to overcome patients' financial burdens related to transplant (9,27,28). Consistent with prior studies (10,(29)(30)(31), we also found that patients in centers with greater proportions of black patients had significantly lower transplant wait-listing rates.…”

Socioeconomic Factors in Access to Renal Transplantation

“…However, a few interventions can be undertaken that might show clinical benefit. Specifically, education programs geared towards improving health literacy may improve the outcome in patients identified as at risk status based on low SAI scores [40]. In addition, navigation systems that streamline the process of transplant evaluation could potentially improve access to renal transplantation [41].…”