Maintaining Equity and Access: Successful Implementation of a Virtual Kidney Transplantation Evaluation.
Maintaining Equity and Access: Successful Implementation of a Virtual Kidney Transplantation Evaluation.
复制标题
维护公平和机会：成功实施虚拟肾移植评估。
DOI：
10.1016/j.jamcollsurg.2020.12.003
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发表时间：
2021
影响因子：
5.2
通讯作者：
Baliga,PrabhakarK
中科院分区：
文献类型：
--
作者：
Rohan,VinayakS;Pilch,Nicole;Cassidy,Deborah;McGillicuddy,John;White,Jared;Lin,Angello;Nadig,SatishN;Taber,DavidJ;Dubay,Derek;Baliga,PrabhakarK
背景：在大流行期间维持肾移植的可及性是一项挑战，特别是对于那些为大量农村和少数民族患者提供服务的中心来说，这是一项额外的旅行负担。本文的目的是描述我们的经验，推出和使用一个虚拟的移植前评估平台，以促进在早期高峰期的COVID-19 pandemic.研究设计：这是一个回顾性分析的过程中实施的改进项目，以继续评估潜在的肾移植候选人，并确保在COVID-19 pandemic期间的等待名单的位置。操作指标包括每月移植量、每月转诊量、每月在完成评估前停止的移植前患者、每月完成的评估和每月等待的患者。结果：在2020年4月至9月期间，共有1，258名患者完成了评估。247名患者在完成全面评价之前在此期间停止。152名患者在选择时提交，113名患者被列入候补名单。此外，处于主动转诊阶段的患者数量减少了46%。在虚拟平台上完成了更多的评估（n= 930 vs n= 880），尽管发生了COVID-19大流行，但2020年（n= 282）与2019年（n= 308）的等待名单增加了类似的数量。结论：虚拟平台允许继续维持大型肾移植计划，尽管无法进行面对面访视。该平台的价值可能会改变我们对移植前过程的方法，并提供一种额外的有价值的方法来改善患者的公平性和获得移植。
BACKGROUND:Maintaining access to kidney transplantation during a pandemic is a challenge, particularly for centers that serve a large rural and minority patient population with an additional burden of travel. The aim of this article was to describe our experience with the rollout and use of a virtual pretransplantation evaluation platform to facilitate ongoing transplant waitlisting during the early peak of the COVID-19 pandemic.STUDY DESIGN:This is a retrospective analysis of the process improvement project implemented to continue the evaluation of potential kidney transplantation candidates and ensure waitlist placement during the COVID-19 pandemic. Operational metrics include transplantation volume per month, referral volume per month, pretransplantation patients halted before completing an evaluation per month, evaluations completed per month, and patients waitlisted per month.RESULTS:Between April and September 2020, a total of 1,258 patients completed an evaluation. Two hundred and forty-seven patients were halted during this time period before completing a full evaluation. One hundred and fifty-two patients were presented at selection and 113 were placed on the waitlist. In addition, the number of patients in the active referral phase was able to be reduced by 46%. More evaluations were completed within the virtual platform (n= 930 vs n= 880), yielding similar additions to the waitlist in 2020 (n= 282) vs 2019 (n= 308) despite the COVID-19 pandemic.CONCLUSIONS:The virtual platform allowed continued maintenance of a large kidney transplantation program despite the inability to have in-person visits. The value of this platform will likely transform our approach to the pretransplantation process and provides an additional valuable method to improve patient equity and access to transplantation.