title: A Randomized Trial to Reduce Disparities in Referral for Transplant Evaluation.
abstract: Georgia has the lowest kidney transplant rates in the United States and substantial racial disparities in transplantation. We determined the effectiveness of a multicomponent intervention to increase referral of patients on dialysis for transplant evaluation in the Reducing Disparities in Access to kidNey Transplantation Community Study (RaDIANT), a randomized, dialysis facility-based, controlled trial involving >9000 patients receiving dialysis from 134 dialysis facilities in Georgia. In December of 2013, we selected dialysis facilities with either low transplant referral or racial disparity in referral. The intervention consisted of transplant education and engagement activities targeting dialysis facility leadership, staff, and patients conducted from January to December of 2014. We examined the proportion of patients with prevalent ESRD in each facility referred for transplant within 1 year as the primary outcome, and disparity in the referral of black and white patients as a secondary outcome. Compared with control facilities, intervention facilities referred a higher proportion of patients for transplant at 12 months (adjusted mean difference [aMD], 7.3%; 95% confidence interval [95% CI], 5.5% to 9.2%; odds ratio, 1.75; 95% CI, 1.36 to 2.26). The difference between intervention and control facilities in the proportion of patients referred for transplant was higher among black patients (aMD, 6.4%; 95% CI, 4.3% to 8.6%) than white patients (aMD, 3.7%; 95% CI, 1.6% to 5.9%;P<0.05). In conclusion, this intervention increased referral and improved equity in kidney transplant referral for patients on dialysis in Georgia; long-term follow-up is needed to determine whether these effects led to more transplants.
authors.affiliation: Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia; rpatzer@emory.edu.|Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.|Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Paul
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.|Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Laura
authors.initials: L
authors.lastname: Plantinga
authors.affiliation: Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gander
authors.affiliation: Southeastern Kidney Council, Inc., End Stage Renal Disease Network 6, Raleigh, North Carolina.
authors.forename: Leighann
authors.initials: L
authors.lastname: Sauls
authors.affiliation: Southeastern Kidney Council, Inc., End Stage Renal Disease Network 6, Raleigh, North Carolina.
authors.forename: Jenna
authors.initials: J
authors.lastname: Krisher
authors.affiliation: Division of Nephrology, Hypertension, and Transplant, Augusta University, Augusta, Georgia.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Mulloy
authors.affiliation: Piedmont Transplant Institute, Atlanta, Georgia.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Gibney
authors.affiliation: University of South Carolina College of Social Work, Columbia, South Carolina; and.
authors.forename: Teri
authors.initials: T
authors.lastname: Browne
authors.affiliation: Division of Nephrology, Hypertension, and Transplant, Augusta University, Augusta, Georgia.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Zayas
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.|Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, Georgia.
authors.forename: Kimberly Jacob
authors.initials: KJ
authors.lastname: Arriola
authors.affiliation: Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Stephen O
authors.initials: SO
authors.lastname: Pastan
mesh_terms: D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016030:Kidney Transplantation; D008875:Middle Aged; D018579:Patient Selection; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014481:United States
keywords: community-based participatory research; dialysis facility; education; kidney transplantation; randomized trial; staff