The beneficial effect of providing kidney transplantation information on transplantation status differs between for‐profit and nonprofit dialysis centers

Abstract

Summary Informing end‐stage kidney disease patients about kidney transplantation options increases the likelihood of kidney transplant waiting list (WL) enrollment and live donor kidney transplant (LDKT) receipt. Patients in for‐profit dialysis centers have lower rates of WL enrollment and LDKT receipt. This study examined if the ownership status of dialysis centers modified the association between informing patients about transplantation options and patients’ transplantation status. Multilevel analysis using mixed‐effect multinomial logistic regression was performed using the United States Renal Data System (USRDS) data (January 2005 to December 2017). The study showed that informing patients improved the odds of WL enrollment and LDKT receipt. However, the effect of informing patients on transplantation status was less pronounced at for‐profit as compared with nonprofit centers (Nonprofit: WL enrollment OR: 2.23 [95% CI: 2.07–2.40], and LDKT receipt OR: 3.35 [95% CI: 2.65–4.25]. For‐profit: WL enrollment OR: 1.73 [95% CI: 1.66–1.79], and LDKT receipt OR: 2.35 [95% CI: 2.08–2.66]), although the odds of informing patients was higher for for‐profit centers, and type of patients informed were similar across both types of centers. Information provided by for‐profit centers was potentially less effective than those provided by nonprofit centers. Standardized guidelines for transplantation information provision are needed in order to ensure similar informational quality across centers.

Optimizing the Timing of Transplant Education

“…Yet recent evidence using these form's data suggests that dialysis facilities vary substantially in the quality and comprehensiveness of the transplant education they provide, and the Centers for Medicare & Medicaid Services 2728 form cannot adequately illuminate this variation. 6 Transplant education is often an iterative process that unfolds over time, and delaying this process risks missing early opportunities to deliver needed information to patients when they can start internalizing and using it. Notably, patient groups who often experience diminished access to timely transplant education-including historically marginalized patients and patients who are uninsured, underinsured, or Medicaid-insured-are also overrepresented among patients who initiate dialysis unexpectedly.…”

“…Yet recent evidence using these form's data suggests that dialysis facilities vary substantially in the quality and comprehensiveness of the transplant education they provide, and the Centers for Medicare & Medicaid Services 2728 form cannot adequately illuminate this variation. 6…”