Increasing Equity in Transplant Evaluation and Living Donor Kidney Transplantation

描述(申请人提供)：活体供肾移植(LDKT)是治疗终末期肾病(ESKD)的最佳方法。但是，肾移植的评估过程对患者来说是漫长、耗时和负担的。此外，在移植评估完成率、移植和LDKT方面也存在种族差异。我们之前和正在进行的NIDDK资助的研究表明，文化因素(如医疗保健方面的歧视、对LDKT的宗教反对)、移植知识和人口统计特征(如年龄、教育程度、收入)独立且显著地预测完成移植评估的时间。2012年12月，我们的移植中心实施了一项为期一天的简化评估程序，称为肾移植快速通道(KTFT)，但尚未对其进行疗效或成本效益评估。因此，我们提出了一项准实验，以确定KTFT(n=1030)与历史对照组(n=1140)的疗效和成本效益，后者是我们目前的NIDDK研究中招募的，以提高移植比率。同时，我们将进行一项针对弱势患者的随机对照试验(RCT)，其中包含Talk干预(谈论活体肾脏捐赠)的教育成分，以增加LDKT。对于应用程序的这两个组件，我们将以弱势人群为目标，因为他们面临评估时间延长和LDKT发生率较低的最大风险。使用CONTORT标准，参与者将被随机分配到Talk(n=515)和非Talk(n=515)条件下，并在移植前工作和完成移植评估时接受两次访谈，目的是：(1)测试KTFT和Talk是否将减少移植评估时间，并增加弱势群体成员的移植和LDKT发生率；(2)确定在移植中心内进行简化和协调的护理评估体验是否减少了对医疗保健系统的负面看法；以及(3)测试使用Talk的KTFT相对于标准做法的成本效益。这种双管齐下的方法的结果将有助于为其他移植中心在其地点实施快速通道系统铺平道路，通过移植更多的脆弱患者来提高护理质量，并可能有助于解决LDKT发生率的明显种族/民族差异。

DESCRIPTION (provided by applicant): Living donor kidney transplantation (LDKT) is the optimal treatment for end-stage kidney disease (ESKD). But, the evaluation process for a kidney transplant is lengthy, time consuming, and burdensome to the patient. Also, race disparities exist in rates of transplant evaluation completion, transplantation, and LDKT. Our previous and ongoing NIDDK-funded research indicates that cultural factors (i.e., perceived discrimination in health care, religious objection to LDKT), transplant knowledge, and demographic characteristics (e.g., age, education, income) independently and significantly predict time to complete transplant evaluation. In December 2012 our transplant center implemented a one-day streamlined evaluation process, dubbed Kidney Transplant Fast Track (KTFT), but it has not been evaluated for efficacy or cost effectiveness. Thus, we propose a quasi-experiment to determine the efficacy and cost-effectiveness of the KTFT (n=1030) compared to historical controls (n=1140) who were recruited for our current NIDDK study to increase transplant rates. At the same time, we will conduct a randomized controlled trial (RCT) targeting vulnerable patients with the educational component of the TALK intervention (Talking About Live Kidney Donation) to increase LDKT. For both components of the application, we will target vulnerable populations because they are most at risk for extended evaluation times and lower rates of LDKT. Using CONSORT standards, participants will be randomly assigned to TALK (n=515) versus no-TALK (n=515) conditions and undergo two interviews at pre-transplant work-up and at completion of transplant evaluation in order to: (1) test whether KTFT and TALK will reduce transplant evaluation time, and increase rates of transplant and LDKT in members of vulnerable groups; (2) determine whether engaging in a streamlined and coordinated-care evaluation experience within the transplant center reduces negative perceptions of the healthcare system; and (3) test the cost effectiveness of the KTFT with TALK relative to standard practices. The results of this two-pronged approach will help pave the way for other transplant centers to implement a Fast Track system at their sites, improve quality of care by transplanting a larger number of vulnerable patients, and may help address stark race/ethnic disparities in rates of LDKT.