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，肾衰竭的公共卫生负担很大，有超过60万例终末期肾病（ESRD）患者。肾脏疾病的治疗主要有两种-透析或肾移植。一个复杂的，多层次的国家系统管理肾脏疾病的护理，报销和移植，创造障碍，以克服在移植，最有效的治疗终末期肾病存在的重大种族差异。器官共享联合网络的联邦器官采购和移植网络监督美国所有已故捐赠器官的分配，并于2014年12月4日实施了分配政策的重大变化，预计将影响移植获得的种族差异。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，以减少移植评估，wit列表和移植的关键步骤中的差异，其中每个步骤在地方和国家层面上都有复杂的测量。此外，为了在服务提供水平上减少差异，我们将使用国家数据来开发并传播系统级实践，向透析中心提供有关其移植性能的反馈，以提高整体等待率并减少肾移植的差异。我们的具体目标是：具体目标1：为了检验新的肾脏分配政策将导致1年时移植差异减少的假设，我们将前瞻性地检查政策变化对移植过程中关键步骤中种族差异的影响。 唯一数据，和B）在美国等待上市和移植。具体目标二：为了评估系统级方法对提供量身定制的移植性能反馈和肾脏分配政策教育的影响，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多组分临床有效性实施研究。我们预计，增加提供者的知识将减少移植等待名单的差异。这一应用的长期影响将是影响美国器官分配的方式，以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。

 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.