We previously identified the steps in the transplant process that are responsible for creating race and gender disparities in access to kidney transplantation. We reasoned that trained kidney transplant recipients may be ideal navigators to help other patients complete these steps. In a recently completed efficacy trial, we demonstrated that dialysis patients randomly assigned to navigators completed three times more steps compared to control patients. Moreover, blacks, whites, men, and women all responded similarly to the intervention, suggesting that navigation may help reduce disparities. However, the navigation intervention was labor intensive, focused on a single geographic area, and was not designed to determine a statistically significant effect on waiting list placement or actual transplantation. Dissemination of successful clinical trial interventions into widespread practice remains a persistent problem. We used a theory-driven approach to address impediments to dissemination of our intervention. In particular, we simplified the intervention, reduced data collection needs, and partnered with multiple transplant centers. We now propose to disseminate and evaluate a streamlined navigator intervention in a four-year, multi-site, cluster randomized trial involving 4 transplant centers, 40 nearby dialysis facilities, and 1800 dialysis patients. A navigator based at each transplant center will provide tailored information and assistance to patients at intervention but not at control facilities. Primary analyses will compare wait listing and transplant rates in the intervention and control groups. Helping patients complete steps in the transplant process may lead not only to reduced disparities in transplantation but also to better patient survival, improved quality of life, and decreased health care costs. The proposed project may also serve as a model for dissemination of other health disparity interventions.

Public Health Relevance

Compared with chronic dialysis treatment, kidney transplantation generally offers a longer life span, a better quality of life, and lower health care costs. However, many kidney failure patients face barriers in moving through the steps required to obtain a transplant. To goal of this project is to determine if trained kidney transplant recipients (

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Comprehensive Center (P60)
Project #
Application #
Study Section
Special Emphasis Panel (ZMD1-RN)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Case Western Reserve University
United States
Zip Code
Huml, Anne M; Sehgal, Ashwini R (2014) BMI, sex, and access to transplantation. Clin J Am Soc Nephrol 9:843-4
Prakash, Suma; Coffin, Rick; Schold, Jesse et al. (2014) Travel distance and home dialysis rates in the United States. Perit Dial Int 34:24-32
Cain, Katrice D; Theurer, Jacqueline R; Sehgal, Ashwini R (2014) Sharing of grant funds between academic institutions and community partners in community-based participatory research. Clin Transl Sci 7:141-4
Hand, Rosa K; Lawless, Mary Ellen; Deming, Nicole et al. (2014) Development and pilot testing of a human subjects protection training course unique to registered dietitian nutritionists. J Acad Nutr Diet 114:2009-16
Thornton, J Daryl; Schold, Jesse D (2013) The authors reply. Crit Care Med 41:e395-6
Thornton, J Daryl; Schold, Jesse D; Venkateshaiah, Lokesh et al. (2013) Prevalence of copied information by attendings and residents in critical care progress notes. Crit Care Med 41:382-8
Schold, J D; Buccini, L D; Heaphy, E L G et al. (2013) The prognostic value of kidney transplant center report cards. Am J Transplant 13:1703-12
Huml, Anne M; Sullivan, Catherine M; Pencak, Julie A et al. (2013) Accuracy of dialysis medical records in determining patients' interest in and suitability for transplantation. Clin Transplant 27:541-5
Leon, Janeen B; Sullivan, Catherine M; Sehgal, Ashwini R (2013) The prevalence of phosphorus-containing food additives in top-selling foods in grocery stores. J Ren Nutr 23:265-270.e2
Schold, J D; Heaphy, E L G; Buccini, L D et al. (2013) Prominent impact of community risk factors on kidney transplant candidate processes and outcomes. Am J Transplant 13:2374-83

Showing the most recent 10 out of 14 publications