The Role of Race and Poverty on Steps to Kidney Transplantation in the Southeastern United States

Patzer, Rachel E.; Perryman, Jennie P.; Schrager, Justin D.; Pastan, Stephen O.; Amaral, Sandra; Gazmararian, Julie A.; Klein, Mitchel; Kutner, Nancy G.; McClellan, William M.

doi:10.1111/j.1600-6143.2011.03927.x

Cited by 137 publications

(162 citation statements)

References 32 publications

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“…However, one promising strategy for improving transplant education in centers with low-SES patients and those in rural areas farther away from transplant centers may be to provide educators with training about transplant's value for their patients; access to more patient-centered educational resources about transplantation; and resources, such as free transportation to a transplant center or more reimbursement for evaluation-related expenses to overcome patients' financial burdens related to transplant (9,27,28). Consistent with prior studies (10,(29)(30)(31), we also found that patients in centers with greater proportions of black patients had significantly lower transplant wait-listing rates. It is known that patients identifying as racial minorities are less likely to receive transplant education (7,32); however, we found a significant race effect on wait-listing rates even when controlling for the number of educational practices occurring within the center.…”

Section: Discussionmentioning

confidence: 55%

Assessing Transplant Education Practices in Dialysis Centers

Waterman

Peipert

Goalby

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives The Centers for Medicare & Medicaid Services (CMS) requires that dialysis centers inform new patients of their transplant options and document compliance using the CMS-2728 Medical Evidence Form (Form-2728). This study compared reports of transplant education for new dialysis patients reported to CMS with descriptions from transplant educators (predominantly dialysis nurses and social workers) of their centers' quantity of and specific educational practices. The goal was to determine what specific transplant education occurred and whether provision of transplant education was associated with center-level variation in transplant wait-listing rates.Design, setting, participants, & measurements Form-2728 data were drawn for 1558 incident dialysis patients at 170 centers in the Heartland Kidney Network (Iowa, Kansas, Missouri, and Nebraska) in 2009-2011; educators at these centers completed a survey describing their transplant educational practices. Educators' own survey responses were compared with Form-2728 reports for patients at each corresponding center. The association of quantity of transplant education practices used with wait-listing rates across dialysis centers was examined using multivariable negative binomial regression.Results According to Form-2728, 77% of patients (n=1203) were informed of their transplant options within 45 days. Educators, who reported low levels of transplant knowledge themselves (six of 12 questions answered correctly), most commonly reported giving oral recommendations to begin transplant evaluation (988 informed patients educated, 81% of centers) and referrals to external transplant education programs (959 informed patients educated, 81% of centers). Only 18% reported having detailed discussions about transplant with their patients. Compared with others, centers that used more than three educational activities (incident rate ratio, 1.36; 95% confidence interval, 1.07 to 1.73) had higher transplant wait-listing rates.Conclusions While most educators inform new patients that transplant is an option, dialysis centers with higher wait-listing rates use multiple transplant education strategies.

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Section: Discussionmentioning

confidence: 55%

Assessing Transplant Education Practices in Dialysis Centers

Waterman

Peipert

Goalby

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Although racial disparities in transplant have been firmly established (3,5), few studies have compared the effect of large sets of less-and more-modifiable patient characteristics to determine where best to intervene to increase patients' successful completion of evaluation and receipt of LDKTs (11). From the beginning of the transplantseeking process, our study found that blacks began transplant evaluation less willing to get on the deceased donor waitlist, less willing for LDKT, and less knowledgeable about the benefits of transplant compared with whites.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the higher prevalence of CKD among blacks (1,2), they are less likely than whites to receive deceased donor transplants (DDKTs) and living donor transplants (LDKTs) (3,4), even after adjusting for clinical and sociodemographic characteristics (5). In 2009, blacks received just 14% of LDKTs, despite being 28% of ESRD incident patients in that year (6,7).…”

Section: Introductionmentioning

confidence: 99%

Modifiable Patient Characteristics and Racial Disparities in Evaluation Completion and Living Donor Transplant

Waterman

Peipert

Hyland

et al. 2013

Clinical Journal of the American Society of Nephrology

119

164

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SummaryBackground and objectives To reduce racial disparities in transplant, modifiable patient characteristics associated with completion of transplant evaluation and receipt of living donor kidney transplant must be identified.Design, setting, participants, & measurements From 2004 to 2007, 695 black and white patients were surveyed about 15 less-modifiable and 10 more-modifiable characteristics at evaluation onset; whether they had completed evaluation within 1 year and received living donor kidney transplants by 2010 was determined. Logistic regression and competing risks time-to-event analysis were conducted to determine the variables that predicted evaluation completion and living donor kidney transplant receipt.Results Not adjusting for covariates, blacks were less likely than whites to complete evaluation (26.2% versus 51.8%, P,0.001) and receive living donor kidney transplants (8.7% versus 21.9%, P,0.001). More-modifiable variables associated with completing evaluation included more willing to be on the waiting list (odds ratio=3.4, 95% confidence interval=2.1, 5.7), more willing to pursue living donor kidney transplant (odds ratio=2.7, 95% confidence interval=1.8, 4.0), having access to more transplant education resources (odds ratio=2.2, 95% confidence interval=1.5, 3.2), and having greater transplant knowledge (odds ratio=1.8, 95% confidence interval=1.2, 2.7). Patients who started evaluation more willing to pursue living donor kidney transplant (hazard ratio=4.3, 95% confidence interval=2.7, 6.8) and having greater transplant knowledge (hazard ratio=1.2, 95% confidence interval=1.1, 1.3) were more likely to receive living donor kidney transplants.Conclusions Because patients who began transplant evaluation with greater transplant knowledge and motivation were ultimately more successful at receiving transplants years later, behavioral and educational interventions may be very successful strategies to reduce or overcome racial disparities in transplant.

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“…Despite strong evidence for improved quality of life and survival after transplantation, there is a large gap between the number of patients who need a kidney transplant and the number of available organs (2). Racial disparities in access to kidney transplantation have been documented in several steps in the renal transplant process, including referral, evaluation completion, and waitlisting (3)(4)(5)(6)(7)(8)(9). The reasons for the disparities are likely multifactorial, and they may not be entirely explained by clinical factors (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Impact of a Patient Education Program on Disparities in Kidney Transplant Evaluation

Patzer

Perryman

Pastan

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives In 2007, the Emory Transplant Center (ETC) kidney transplant program implemented a required educational session for ESRD patients referred for renal transplant evaluation to increase patient awareness and decrease loss to follow-up. The purpose of this study was to evaluate the association of the ETC education program on completion of the transplant evaluation process.Design, setting, participants, & measurements Incident, adult ESRD patients referred from 2005 to 2008 were included. Patient data were abstracted from medical records and linked with data from the United States Renal Data System. Evaluation completion was compared by pre-and posteducational intervention groups in binomial regression models accounting for temporal confounding.Results A total of 1126 adult ESRD patients were examined in two transplant evaluation eras (75% pre-and 25% postintervention). One-year evaluation completion was higher in the post-versus preintervention group (80.4% versus 44.7%, P,0.0001). In adjusted analyses controlling for time trends, the adjusted probability of evaluation completion at 1 year was higher among the intervention versus nonintervention group (risk ratio=1.38, 95% confidence interval=1.12-1.71). The effect of the intervention was stronger among black patients and those patients living in poor neighborhoods (likelihood ratio test for interaction, P,0.05).Conclusions Standardizing transplant education may help reduce some of the racial and socioeconomic disparities observed in kidney transplantation.

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The Role of Race and Poverty on Steps to Kidney Transplantation in the Southeastern United States

Cited by 137 publications

References 32 publications

Assessing Transplant Education Practices in Dialysis Centers

Assessing Transplant Education Practices in Dialysis Centers

Modifiable Patient Characteristics and Racial Disparities in Evaluation Completion and Living Donor Transplant

Impact of a Patient Education Program on Disparities in Kidney Transplant Evaluation

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