Greater community vulnerability is associated with poor living donor navigator program fidelity

Killian, A. Cozette; Carter, Alexis J.; Reed, Rhiannon D.; Shelton, Brittany A.; Qu, Haiyan; McLeod, M. Chandler; Orandi, Babak J.; Cannon, Robert M.; Anderson, Douglas J.; MacLennan, Paul A.; Kumar, Vineeta; Hanaway, Michael J.; Locke, Jayme E.

doi:10.1016/j.surg.2022.04.033

Cited by 6 publications

(7 citation statements)

References 25 publications

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“…Our group has previously found that the lower than expected kidney donation rate in the Gulf states could largely be accounted for by a higher prevalence of deleterious social factors contained within the County Health Rankings 28. Such findings also extend to living donation, where patients from socially vulnerable communities, particularly those remote from a transplant center, were significantly less likely to access resources provided to assist with identification of a living donor 24,29…”

Section: Discussionmentioning

confidence: 69%

“…28 Such findings also extend to living donation, where patients from socially vulnerable communities, particularly those remote from a transplant center, were significantly less likely to access resources provided to assist with identification of a living donor. 24,29 The outcomes and covariates we measured were at the population level, and thus ecological in nature. As such, any conclusions we can draw must be limited to the population level.…”

Section: Discussionmentioning

confidence: 99%

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Perpetuating Disparity

et al. 2022

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Background: The burden of end-stage kidney disease (ESKD) and kidney transplant rates vary significantly across the United States. This study aims to examine the mismatch between ESKD burden and kidney transplant rates from a perspective of spatial epidemiology. Methods: US Renal Data System data from 2015 to 2017 on incident ESKD and kidney transplants per 1000 incident ESKD cases was analyzed. Clustering of ESKD burden and kidney transplant rates at the county level was determined using local Moran’s I and correlated to county health scores. Higher percentile county health scores indicated worse overall community health. Results: Significant clusters of high-ESKD burden tended to coincide with clusters of low kidney transplant rates, and vice versa. The most common cluster type had high incident ESKD with low transplant rates (377 counties). Counties in these clusters had the lowest overall mean transplant rate (61.1), highest overall mean ESKD incidence (61.3), and highest mean county health scores percentile (80.9%, P<0.001 vs all other cluster types). By comparison, counties in clusters with low ESKD incidence and high transplant rates (n=359) had the highest mean transplant rate (110.6), the lowest mean ESKD incidence (28.9), and the lowest county health scores (20.2%). All comparisons to high-ESKD/low-transplant clusters were significant at P value <0.001. Conclusion: There was a significant mismatch between kidney transplant rates and ESKD burden, where areas with the greatest need had the lowest transplant rates. This pattern exacerbates pre-existing disparities, as disadvantaged high-ESKD regions already suffer from worse access to care and overall community health, as evidenced by the highest county health scores in the study.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Perpetuating Disparity

et al. 2022

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“…26 Our group has previously demonstrated an association between living in a community characterized by high SVI (ie, more vulnerable) and decreased access to living donor kidney transplantation. [27][28][29] As the original SVI is calculated at the census tract level, the SVI methodology was utilized to create an index for the HRR level. Each individual component of the SVI was weighted by population (component score x census tract population…”

Section: Patient Populationmentioning

confidence: 99%

Regional Social Vulnerability is Associated with Geographic Disparity in Waitlist Outcomes for Patients with Non-HCC MELD Exceptions in the United States

Cannon,

Goldberg,

Sheikh

et al. 2023

Annals of Surgery

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Background: This study was undertaken to evaluate the role of regional social vulnerability in geographic disparity for patients listed for liver transplant with non-HCC MELD exceptions. Methods: Adults listed at a single center for a first time liver only transplant without HCC after June 18, 2013 in the SRTR database as of March 2021 were examined. Candidates were mapped to hospital referral regions (HRRs). Adjusted likelihood of mortality and liver transplant were modeled. Advantaged HRRs were defined as those where exception patients were more likely to be transplanted, yet no more likely to die in adjusted analysis. The Centers for Disease Control’s Social Vulnerability Index (SVI) was used as the measure for community health. Higher SVIs indicate poorer community health. Results: There were 49,494 candidates in the cohort, of whom 4,337 (8.8%) had MELD exceptions. Among continental US HRRs, 27.3% (n=78) were identified as advantaged. The mean SVI of advantaged HRRs was 0.42 vs. 0.53 in non-advantaged HRRs (P=0.002), indicating better community health in these areas. Only 25.3% of advantaged HRRs were in spatial clusters of high SVI vs. 40.7% of non-advantaged HRRs, while 44.6% of advantaged HRRs were in spatial clusters of low SVI vs.38.0% of non-advantaged HRRs (P=0.037). Conclusion: Advantage for non-HCC MELD exception patients is associated with lower social vulnerability on a population level. These findings suggest assigning similar waitlist priority to all non-HCC exception candidates without considering geographic differences in social determinants of health may actually exacerbate rather than ameliorate disparity.

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“…5 Patients with end-stage kidney disease across sex, race/ethnicity, age, socioeconomic status, and geographic boundaries are disproportionately disadvantaged, low-resourced, and lack adequate transportation compared to the general population [7][8][9][10] ; often, additive resources, such as advocacy training programs, perpetuate difficulties in program uptake and sustainability in such a vulnerable population. 11 Thus, innovative strategies designed to bring the living donor kidney transplantation educational programming to the participant, such as telehealth, are warranted.…”

Section: Introductionmentioning

confidence: 99%

“…While telehealth may overcome geographic disparities created by in-person programming, ensuring programmatic fidelity across delivery modality (in-person vs telehealth) is paramount for continued success. 11,14 The purpose of the current formative research study was to leverage the mixed-methodology, nominal group technique (NGT), to garner perspectives on expanding the LDN Program to include telehealth/tele-navigation delivery in addition to in-person engagement.…”

Section: Introductionmentioning

confidence: 99%

Interpersonal Connections Are Important for Virtual Kidney Transplant Educational Program Development

Carter,

Qu,

Reed

et al. 2023

Prog Transpl

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Introduction: The Living Donor Navigator program is designed to mitigate disparities in living donor kidney transplantation, although geographic disparities in program participation were observed in the initial years of implementation. The purpose of this study was to understand participant perspectives regarding the use of a virtual option/alternative to expand program participation. Methods: Previous participants of the in-person navigator program were purposively sampled. Using the nominal group technique, a well-structured formative methodology to elicit participant perspectives, 2 meetings were conducted among transplant recipients and advocates (N = 13) to identify and prioritize responses to the question “What things would concern you about participating in a virtual and remote Living Donor Navigator program?” Findings: Mean participant age was 59.3 (9.3) years, and participants were 54% male and 62% white. Education levels varied from less than high school to master’s degrees. Participants generated 70 unique responses, of which 36 (51.4%) received prioritization. The top 5 ranked responses of each nominal group technique meeting received approximately 50 percent (47.6% vs. 66.7%, respectively) of the total votes and described the potentially limited interpersonal connections, time conflicts, and differing content in a virtual navigator program compared to the in-person model. Discussion: These data suggest that previous participants were concerned with upholding the original design of the program, thus, virtual living donor kidney transplantation programs should aim to maintain interpersonal connections and consistency of content to ensure adequate programmatic engagement. Future research will focus on program fidelity independent of delivery modality.

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Greater community vulnerability is associated with poor living donor navigator program fidelity

Cited by 6 publications

References 25 publications

Perpetuating Disparity

Perpetuating Disparity

Regional Social Vulnerability is Associated with Geographic Disparity in Waitlist Outcomes for Patients with Non-HCC MELD Exceptions in the United States

Interpersonal Connections Are Important for Virtual Kidney Transplant Educational Program Development

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