Evaluation of Racial Disparities in Access to Kidney Transplantation in New National Kidney Allocation Policy

 描述(由申请人提供)：在美国，肾衰竭造成的公共健康负担很大，有60多万终末期肾病(ESRD)患者。肾脏疾病有两种主要的治疗方法--透析或肾移植。一个复杂的、多层次的国家系统监管肾脏疾病的护理、报销和移植，为克服移植中存在的显著种族差异创造了障碍，移植是终末期肾病最有效的治疗方法。器官共享联合网络的联邦器官采购和移植网络负责监督美国所有已故捐献器官的分配，2014年12月4日，分配政策发生了重大变化，预计将影响移植机会的种族差异。我们建议研究制定这一新的肾脏分配政策所提供的自然实验的影响，以减少在转诊进行移植评估、智商列出和移植的关键步骤中的差异，这些步骤在地方和国家层面上都有测量的复杂性。此外，为了在服务提供层面减少差距，我们将利用国家数据开发并传播一种系统层面的做法，即向透析中心提供关于其移植性能的反馈，以提高总体等待名单比率，减少肾移植中的差距。我们的具体目标是：具体目标1：为了测试新的肾脏分配政策将在一年内减少移植差异的假设，我们将前瞻性地检查政策变化对移植过程中分配后和分配前的关键步骤中种族差异的影响：a)从透析机构转诊到东南部进行移植评估，在那里我们可以获得 独一无二的数据，以及b)等待在美国上市和移植。具体目标2：为了评估提供量身定制的移植性能反馈和肾脏分配政策教育的系统级方法的影响，我们将在750家治疗50,000名透析患者的美国透析机构中进行一项多成分的临床有效性实施研究。我们预计，越来越多的提供者知识将减少移植等待名单上的差异。这项申请的长期影响将是影响美国器官分配的方式，通过更好地分析政策和传播卫生系统层面的最佳做法来确保公平性。

 DESCRIPTION (provided by applicant): The public health burden of kidney failure in the United States is substantial, with more than 600,000 end-stage renal disease (ESRD) patients. There are two main treatments for kidney disease - dialysis or kidney transplantation. A complex, multi-tiered national system regulates kidney disease care, reimbursement, and transplantation, creating barriers to overcoming the significant racial disparities that exist in transplantation, the most effective treatment for ESRD. The federal Organ Procurement and Transplantation Network of the United Network for Organ Sharing oversees the allocation of all deceased donor organs in the US, and on Dec. 4, 2014, a major change to the allocation policy was implemented that is expected to impact racial disparities in transplantation access. We propose to study the impact of the natural experiment offered by enactment of this new kidney allocation policy on reducing disparities in the key steps of referral for transplant evaluation, wit listing, and transplantation, each of which have complexities for measurement at the local and national level. In addition, to impact disparities reduction at the service delivery level, we willuse national data to develop and then disseminate a systems-level practice of providing feedback to dialysis centers about their transplant performance to improve overall wait listing rates and decrease disparities in kidney transplantation. Our specific aims are: Specific Aim 1: To test the hypothesis that the new kidney allocation policy will lead to a reduction in disparities in transplantation at 1 year, we will prospectively examine the impact of the policy changes on racial disparities in the key steps in the transplant process post- vs. pre- allocation: a) referra from the dialysis facility for transplant evaluation in the Southeast, where we have access to this unique data, and b) wait listing and transplantation in the US. Specific Aim 2: To evaluate the impact of a systems-level approach to providing tailored transplant performance feedback and education about the kidney allocation policy, we will conduct a multicomponent, clinical effectiveness-implementation study among 750 US dialysis facilities which treat >50,000 dialysis patients. We anticipate that increasing provider knowledge will reduce disparities in transplant wait listing. The long-term impact of this application will be to influence the way organs are allocated in the US to ensure equitability through better analysis of policy and dissemination of best practices at the health systems level.