Effectiveness of a culturally competent care intervention in reducing disparities in Hispanic live donor kidney transplantation: A hybrid trial

Abstract

Hispanic patients receive disproportionately fewer living donor kidney transplants (LDKTs) than non‐Hispanic Whites (NHWs). The Northwestern Medicine Hispanic Kidney Transplant Program (HKTP), designed to increase Hispanic LDKTs, was evaluated as a nonrandomized, implementation‐effectiveness hybrid trial of patients initiating transplant evaluation at two intervention and two similar control sites. Using a mixed method, observational design, we evaluated the fidelity of the HKTP implementation at the two intervention sites. We tested the impact of the HKTP intervention by evaluating the likelihood of receiving LDKT comparing pre‐intervention (January 2011–December 2016) and postintervention (January 2017–March 2020), across ethnicity and centers. The HKTP study included 2063 recipients. Intervention Site A exhibited greater implementation fidelity than intervention Site B. For Hispanic recipients at Site A, the likelihood of receiving LDKTs was significantly higher at postintervention compared with pre‐intervention (odds ratio [OR] = 3.17 95% confidence interval [1.04, 9.63]), but not at the paired control Site C (OR = 1.02 [0.61, 1.71]). For Hispanic recipients at Site B, the likelihood of receiving an LDKT did not differ between pre‐ and postintervention (OR = 0.88 [0.40, 1.94]). The LDKT rate was significantly lower for Hispanics at paired control Site D (OR = 0.45 [0.28, 0.90]). The intervention significantly improved LDKT rates for Hispanic patients at the intervention site that implemented the intervention with greater fidelity. Registration: ClinicalTrials.gov registered (retrospectively) on September 7, 2017 (NCT03276390).

Sustainment of a complex culturally competent care intervention for Hispanic living donor kidney transplantation: A longitudinal analysis of adaptations

“…In the primary outcomes paper for this study [28], we found that HKTP effectively increased LDKT in Hispanic patients at one of two intervention sites, in comparison to pre-/post-assessments at two matched control sites. The study included 2,063 recipients.…”

“…The study included 2,063 recipients. Site-A improved the Hispanic LDKT rate by 47% (from 20.3% at pre-HKTP to 29.8% at post-HKTP), Site-A exhibited greater fidelity to the protocol than Site-B, which may partially explain why Site-A observed intervention effects during the study; additional findings are described elsewhere [28]. Further, our previous research (manuscript under review) [38] found that CFIR inner setting factors (i.e., structural characteristics, culture, compatibility, available resources) influenced the initial adaptations of HKTP.…”

“…As a multi-level intervention, HKTP is comprised of multiple components and strategies, as shown elsewhere [28]. HKTP provides the same standard of care to patients receiving transplant evaluation while using a different care delivery process [35].…”

“…They must also maintain a bicultural/ bilingual team and the availability of interpreters or interpreter services. The implementation strategies used in this study also suggest that ongoing training, in-service presentations to local transplant stakeholders, marketing campaigns, ongoing data monitoring for quality assurance, and learning collaboratives might be necessary, but the pre-post non-randomized study design did not allow formal testing [28].…”

“…HKTP addresses these multi-level factors contributing to disparities. HKTP was associated with a 47% increase in living donor kidney transplantation among Hispanic patients at one of two intervention sites to no detriment to other ethnic/racial groups [28].…”