Reducing disparities in kidney transplantation for Spanish-speaking patients through creation of a dedicated center

Abstract

Introduction Hispanic Americans receive disproportionately fewer organ transplants than non-Hispanic whites. In 2018, the Hispanic Kidney Transplant Program (HKTP) was established as at the University of Colorado Hospital (UCH). The purpose of this quality improvement study was to examine the effect of this culturally sensitive program in reducing disparities in kidney transplantation. Methods We performed a mixed-methods analysis of data from 436 Spanish-speaking patients referred for transplant to UCH between 2015 and 2020. We compared outcomes for patients referred between 2015–2017 (n = 156) to those referred between 2018–2020 (n = 280). Semi-structured phone interviews were conducted with 6 patients per time period and with 6 nephrology providers in the Denver Metro Area. Patients and providers were asked to evaluate communication, transplant education, and overall experience. Results When comparing the two time periods, there was a significant increase in the percentage of patients being referred (79.5% increase, p-0.008) and evaluated for transplant (82.4% increase, p = 0.02) during 2018–2020. While the number of committee reviews and number waitlisted increased during 2018–2020, it did not reach statistical significance (82.9% increase, p = 0.37 and 79.5% increase, p = 0.75, respectively. During patient and provider interviews, we identified 4 themes reflecting participation in the HKTP: improved communication, enhanced patient education, improved experience and areas for advancement. Overall, patients and providers reported a positive experience with the HKTP and noted improved patient understanding of the transplantation process. Conclusions The establishment of the HKTP is associated with a significant increase in Spanish-speaking Hispanic patients being referred and evaluated for kidney transplantation.

The Transplant Experience for Undocumented Immigrant Patients Formerly Receiving Emergency Dialysis and Caregivers

“…To pass the financial screen, the patient needs to demonstrate the ability to finance insurance copayments after the first calendar year of transplant, when their charity-funded insurance ends . Third, our participants did not report issues with language and culture concordance during the transplant process due to the advent of a culture-concordant transplant center in Colorado, which may not be transferable to other centers.…”

Preferred language and disease severity predict evaluation for liver transplantation among patients admitted with alcohol-associated hepatitis

“…A similar study evaluating kidney transplant centers identified only 38 (17%) who provided these non-English language website resources [20]. One center recently reported the implementation of a culturally sensitive transplant program for Spanish-speaking patients, noting a 79% increase in referrals attributed to the program [21]. These data are concordant with referral patterns in language-discordant care among other nontransplant surgical specialties in which non-English speaking patients face barriers to receiving and presenting for referral visits as well as ultimately undergoing the necessary operation [22,23].…”

Barriers to home dialysis and kidney transplantation for socially disadvantaged individuals

“…Further, assisted PD, where a trained caregiver helps patients dialyze, has shown success in alleviating the barriers of limited social support and is reimbursed by healthcare systems in Canada, Denmark, and France [74 ▪ ]. In transplant, culturally concordant transplant education and evaluation has demonstrated an improvement in in disparities among both Black and non-English speaking individuals [75,76 ▪ ,77]. Many programs have also worked to improve delivery of education about home modalities and transplantation to patients [78,79].…”