Health system outreach to eliminate disparities in living kidney transplants

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PROJECT SUMMARY Despite their nearly four-fold greater incidence of end stage kidney disease compared to Whites, African Americans have lower rates of early living donor kidney transplantation (LDKT), an optimal treatment for end stage kidney disease. Disparities in receipt of LDKT have worsened over the past decade. At least four critical roadblocks hinder patients’ journey along the path to receiving LDKTs, including their lack of awareness of their need for LDKT; poor knowledge of LDKT and difficulties discussing LDKT with family and physicians; infrequent or sluggish referrals for early transplant evaluations; and difficulty completing the multi-step transplant evaluation process. African Americans may more frequently face these critical roadblocks when compared to others. Rigorously studied interventions simultaneously addressing these critical roadblocks do not exist. Health systems have numerous capabilities (including information and staffing resources) that could be creatively leveraged to address the multiple critical roadblocks to LDKT that contribute to disparities. However, studies quantifying the effectiveness of interventions which harness and coordinate health system resources to mitigate LDKT disparities have not been performed, leaving an evidence gap. We propose to study an innovative intervention, “Health System Surveillance and Outreach,” designed to overcome multiple roadblocks which lead to LDKT disparities. We will conduct a comparative effectiveness trial to quantify the effectiveness of ‘Health System Surveillance and Outreach’ compared to usual care to mitigate race disparities in LDKT. Our study will be conducted within two large health systems in the Southern US, where disparities in kidney disease are extremely prevalent, and where LDKT is most desperately needed. Health System Surveillance and Outreach will integrate a surveillance registry into electronic health information systems to identify all potential candidates for pre-emptive or early LDKT early and equitably by using patients’ laboratory data and a validated computer-generated kidney disease progression risk prediction algorithm. Transplant social workers and coordinators, who are already embedded in transplant teams, will ‘reach out’ to identified potential LDKT candidates to help them address contextual factors (including educational, social, logistical, and navigation needs) that pose roadblocks to LDKT. Our two primary outcomes will measure patients’ initiation and completion of kidney transplant evaluations using health system records. We will also measure the effectiveness of our navigation support on the kidney transplant evaluation process. This study will provide evidence needed to eliminate LDKT disparities in the South and across the nation.