Implementation of the ASCENT Trial to Improve Transplant Waitlisting Access
Introduction: The Allocation System for changes in Equity in Kidney Transplantation (ASCENT) study was a hybrid type 1 trial of a multicomponent intervention among 655 US dialysis facilities with low kidney transplant waitlisting to educate staff and patients about kidney allocation system (KAS) cha...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S246802492301570X |
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| author | Megan Urbanski Yi-Ting Hana Lee Cam Escoffery Jade Buford Laura Plantinga Stephen O. Pastan Reem Hamoda Emma Blythe Rachel E. Patzer |
| author_facet | Megan Urbanski Yi-Ting Hana Lee Cam Escoffery Jade Buford Laura Plantinga Stephen O. Pastan Reem Hamoda Emma Blythe Rachel E. Patzer |
| author_sort | Megan Urbanski |
| collection | DOAJ |
| description | Introduction: The Allocation System for changes in Equity in Kidney Transplantation (ASCENT) study was a hybrid type 1 trial of a multicomponent intervention among 655 US dialysis facilities with low kidney transplant waitlisting to educate staff and patients about kidney allocation system (KAS) changes and increase access to and reduce racial disparities in waitlisting. Intervention components included a staff webinar, patient and staff educational videos, and facility-specific feedback reports. Methods: Implementation outcomes were assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework. Postimplementation surveys were administered among intervention group facilities (n = 334); interviews were conducted with facility staff (n = 6). High implementation was defined as using 3 to 4 intervention components, low implementation as using 1 to 2 components, and nonimplementation as using no components. Results: A total of 331 (99%) facilities completed the survey; 57% were high implementers, 31% were low implementers, and 12% were nonimplementers. Waitlisting events were higher or similar among high versus low implementer facilities for incident and prevalent populations; for Black incident patients, the mean proportion waitlisted in low implementer facilities was 0.80% (95% confidence interval [CI]: 0.73–0.87) at baseline and 0.55% at 1-year (95% CI: 0.48–0.62) versus 0.83% (95% CI: 0.78–0.88) at baseline and 1.40% at 1-year (95% CI: 1.35–1.45) in high implementer facilities. Interviews revealed that the intervention helped facilities prioritize transplant education, but that intervention components were not uniformly shared. Conclusion: The findings provide important context to interpret ASCENT effectiveness results and identified key barriers and facilitators to consider for future modification and scale-up of multilevel, multicomponent interventions in dialysis settings. |
| format | Article |
| id | doaj-art-d0d9ad6a3f304635a895b80c061fc363 |
| institution | OA Journals |
| issn | 2468-0249 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-d0d9ad6a3f304635a895b80c061fc3632025-08-20T02:31:47ZengElsevierKidney International Reports2468-02492024-02-019222523810.1016/j.ekir.2023.10.028Implementation of the ASCENT Trial to Improve Transplant Waitlisting AccessMegan Urbanski0Yi-Ting Hana Lee1Cam Escoffery2Jade Buford3Laura Plantinga4Stephen O. Pastan5Reem Hamoda6Emma Blythe7Rachel E. Patzer8Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA; Health Services Research Center, Emory University, Atlanta, Georgia, USADivision of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USADepartment of Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, Georgia, USARegenstrief Institute, Indianapolis, Indiana, USAUniversity of California San Francisco, Department of Medicine, Divisions of Rheumatology and Nephology, San Francisco, California, USADivision of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USADivision of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USAHealth Services Research Center, Emory University, Atlanta, Georgia, USADivision of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA; Regenstrief Institute, Indianapolis, Indiana, USA; Indiana University School of Medicine, Department of Surgery, Indianapolis, Indiana, USA; Correspondence: Rachel E. Patzer, Regenstrief Institute, Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, Indiana 46202, USA.Introduction: The Allocation System for changes in Equity in Kidney Transplantation (ASCENT) study was a hybrid type 1 trial of a multicomponent intervention among 655 US dialysis facilities with low kidney transplant waitlisting to educate staff and patients about kidney allocation system (KAS) changes and increase access to and reduce racial disparities in waitlisting. Intervention components included a staff webinar, patient and staff educational videos, and facility-specific feedback reports. Methods: Implementation outcomes were assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework. Postimplementation surveys were administered among intervention group facilities (n = 334); interviews were conducted with facility staff (n = 6). High implementation was defined as using 3 to 4 intervention components, low implementation as using 1 to 2 components, and nonimplementation as using no components. Results: A total of 331 (99%) facilities completed the survey; 57% were high implementers, 31% were low implementers, and 12% were nonimplementers. Waitlisting events were higher or similar among high versus low implementer facilities for incident and prevalent populations; for Black incident patients, the mean proportion waitlisted in low implementer facilities was 0.80% (95% confidence interval [CI]: 0.73–0.87) at baseline and 0.55% at 1-year (95% CI: 0.48–0.62) versus 0.83% (95% CI: 0.78–0.88) at baseline and 1.40% at 1-year (95% CI: 1.35–1.45) in high implementer facilities. Interviews revealed that the intervention helped facilities prioritize transplant education, but that intervention components were not uniformly shared. Conclusion: The findings provide important context to interpret ASCENT effectiveness results and identified key barriers and facilitators to consider for future modification and scale-up of multilevel, multicomponent interventions in dialysis settings.http://www.sciencedirect.com/science/article/pii/S246802492301570Xdialysisdisparitiesimplementation sciencekidney allocation systemkidney transplantmulticomponent intervention |
| spellingShingle | Megan Urbanski Yi-Ting Hana Lee Cam Escoffery Jade Buford Laura Plantinga Stephen O. Pastan Reem Hamoda Emma Blythe Rachel E. Patzer Implementation of the ASCENT Trial to Improve Transplant Waitlisting Access Kidney International Reports dialysis disparities implementation science kidney allocation system kidney transplant multicomponent intervention |
| title | Implementation of the ASCENT Trial to Improve Transplant Waitlisting Access |
| title_full | Implementation of the ASCENT Trial to Improve Transplant Waitlisting Access |
| title_fullStr | Implementation of the ASCENT Trial to Improve Transplant Waitlisting Access |
| title_full_unstemmed | Implementation of the ASCENT Trial to Improve Transplant Waitlisting Access |
| title_short | Implementation of the ASCENT Trial to Improve Transplant Waitlisting Access |
| title_sort | implementation of the ascent trial to improve transplant waitlisting access |
| topic | dialysis disparities implementation science kidney allocation system kidney transplant multicomponent intervention |
| url | http://www.sciencedirect.com/science/article/pii/S246802492301570X |
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