title: Assessing Transplant Education Practices in Dialysis Centers: Comparing Educator Reported and Medicare Data.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors: Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri; awaterman@mednet.ucla.edu.
authors: Amy D
authors: AD
authors: Waterman
authors: Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri;
authors: John D
authors: JD
authors: Peipert
authors: Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri;
authors: Christina J
authors: CJ
authors: Goalby
authors: Heartland Kidney Network, Kansas City, Missouri; and.
authors: Katrina M
authors: KM
authors: Dinkel
authors: Center for Outcomes Research and Abdominal Transplantation Center, Saint Louis University School of Medicine, St. Louis, Missouri.
authors: Huiling
authors: H
authors: Xiao
authors: Center for Outcomes Research and Abdominal Transplantation Center, Saint Louis University School of Medicine, St. Louis, Missouri.
authors: Krista L
authors: KL
authors: Lentine
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007484:Iowa; D007615:Kansas; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000193:education*; D008297:Male; D019221:Mandatory Reporting; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D008923:Missouri; D009329:Nebraska; D064647:Nephrology Nursing / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D006435:Renal Dialysis; D012947:Social Work / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D014850:Waiting Lists
keywords: Transplant education practices; Wait-listing; dialysis; ethnicity; kidney transplantation