title: Protocol of the KTFT-TALK study to reduce racial disparities in kidney transplant evaluation and living donor kidney transplantation.
abstract: Living donor kidney transplantation (LDKT) is the optimal treatment for end-stage kidney disease (ESKD). The evaluation process for a kidney transplant is complex, time consuming, and burdensome to the ESKD patient. Also, race disparities exist in rates of transplant evaluation completion, transplantation, and LDKT. In December 2012 our transplant center implemented a streamlined, one-day evaluation process, dubbed Kidney Transplant Fast Track (KTFT). This paper describes the protocol of a two-part study to evaluate the effectiveness of KTFT at increasing transplant rates (compared to historical controls) and the TALK intervention (Talking About Live Kidney Donation) at increasing LDKT during KTFT. All participants will receive the KTFT evaluation as part of their usual care. Participants will be randomly assigned to TALK versus no-TALK conditions. Patients will undergo interviews at pre-transplant work-up and transplant evaluation. Transplant status will be tracked via medical records. Our aims are to: (1) test the efficacy and cost effectiveness of the KTFT in reducing time to complete kidney transplant evaluation, and increasing kidney transplant rates relative to standard evaluation practices; (2) test whether TALK increases rates of LDKT during KTFT; and (3) determine whether engaging in a streamlined and coordinated-care evaluation experience within the transplant center reduces negative perceptions of the healthcare system. The results of this two-pronged approach will help pave the way for other transplant centers to implement a fast-track system at their sites, improve quality of care by transplanting a larger number of vulnerable patients, and address stark race/ethnic disparities in rates of LDKT.
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
authors.forename: Kellee
authors.initials: K
authors.lastname: Bornemann
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
authors.forename: Emilee
authors.initials: E
authors.lastname: Croswell
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
authors.forename: Menna
authors.initials: M
authors.lastname: Abaye
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Bryce
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Health Equity Research and Promotion, Pittsburgh VA Healthcare System, Pittsburgh, PA, United States; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Chung-Chou H
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Good
authors.affiliation: Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Cathleen A
authors.initials: CA
authors.lastname: Freehling Heiles
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States; Department of Psychology, University of Pittsburgh, PA, United States; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.affiliation: Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States.
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
authors.forename: Amit D
authors.initials: AD
authors.lastname: Tevar
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Health Equity Research and Promotion, Pittsburgh VA Healthcare System, Pittsburgh, PA, United States; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: myaskov@pitt.edu.
authors.forename: Larissa
authors.initials: L
authors.lastname: Myaskovsky
mesh_terms: D001741:Black or African American; D005006:Ethnicity; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D065386:Historically Controlled Study; D006801:Humans; D007198:Indians, North American; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D044465:White People