Impact of navigators on completion of steps in the kidney transplant process: a randomized, controlled trial.
OBJECTIVE
Many patients with ESRD, particularly minorities and women, face barriers in completing the steps required to obtain a transplant. These eight sequential steps are as follows: medical suitability, interest in transplant, referral to a transplant center, first visit to center, transplant workup, successful candidate, waiting list or identify living donor, and receive transplant. This study sought to determine the effect of navigators on completion of steps.


METHODS
Cluster randomized, controlled trial at 23 Ohio hemodialysis facilities. One hundred sixty-seven patients were recruited between January 2009 and August 2009 and were followed for up to 24 months or until study end in February 2011. Trained kidney transplant recipients met monthly with intervention participants (n=92), determined their step in the transplant process, and provided tailored information and assistance in completing the step. Control participants (n=75) continued to receive usual care. The primary outcome was the number of transplant process steps completed.


RESULTS
Starting step did not significantly differ between the two groups. By the end of the trial, intervention participants completed more than twice as many steps as control participants (3.5 versus 1.6 steps; difference, 1.9 steps; 95% confidence interval, 1.3-2.5 steps). The effect of the intervention on step completion was similar across race and sex subgroups.


CONCLUSIONS
Use of trained transplant recipients as navigators resulted in increased completion of transplant process steps.
Center for Reducing Health Disparities, Department of Medicine, Case Western Reserve University, Cleveland, OH 44109, USA.
Catherine
C
Sullivan
Janeen B
JB
Leon
Srilekha S
SS
Sayre
Marquisha
M
Marbury
Michael
M
Ivers
Julie A
JA
Pencak
Kenneth A
KA
Bodziak
Donald E
DE
Hricik
E Janie
EJ
Morrison
Jeffrey M
JM
Albert
Sankar D
SD
Navaneethan
Christina M Delos
CM
Reyes
Ashwini R
AR
Sehgal
D000293:Adolescent; D000328:Adult; D000368:Aged; D046148:Donor Selection; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D016014:Linear Models; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010342:Patient Acceptance of Health Care; D010352:Patient Dropouts; D010353:Patient Education as Topic; D062526:Patient Navigation; D018579:Patient Selection; D010379:Peer Group; D012017:Referral and Consultation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult