Reducing Disparities in Access to Kidney Transplantation

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We previously identified the steps in the transplant process that are responsible for creating race and gender disparities in access to kidney transplantation. We reasoned that trained kidney transplant recipients may be ideal navigators to help other patients complete these steps. In a recently completed efficacy trial, we demonstrated that dialysis patients randomly assigned to navigators completed three times more steps compared to control patients. Moreover, blacks, whites, men, and women all responded similarly to the intervention, suggesting that navigation may help reduce disparities. However, the navigation intervention was labor intensive, focused on a single geographic area, and was not designed to determine a statistically significant effect on waiting list placement or actual transplantation. Dissemination of successful clinical trial interventions into widespread practice remains a persistent problem. We used a theory-driven approach to address impediments to dissemination of our intervention. In particular, we simplified the intervention, reduced data collection needs, and partnered with multiple transplant centers. We now propose to disseminate and evaluate a streamlined navigator intervention in a four-year, multi-site, cluster randomized trial involving 4 transplant centers, 40 nearby dialysis facilities, and 1800 dialysis patients. A navigator based at each transplant center will provide tailored information and assistance to patients at intervention but not at control facilities. Primary analyses will compare wait listing and transplant rates in the intervention and control groups. Helping patients complete steps in the transplant process may lead not only to reduced disparities in transplantation but also to better patient survival, improved quality of life, and decreased health care costs. The proposed project may also serve as a model for dissemination of other health disparity interventions.