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 (

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Comprehensive Center (P60)
Project #
5P60MD002265-08
Application #
8618788
Study Section
Special Emphasis Panel (ZMD1)
Project Start
Project End
Budget Start
2014-02-01
Budget End
2015-01-31
Support Year
8
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Case Western Reserve University
Department
Type
DUNS #
City
Cleveland
State
OH
Country
United States
Zip Code
44106
Pelfrey, Clara M; Cain, Katrice D; Lawless, Mary Ellen et al. (2017) A Consult Service to Support and Promote Community-Based Research: Tracking and Evaluating a Community-based Research Consult Service. J Clin Transl Sci 1:33-39
Sullivan, Catherine M; Pencak, Julie A; Freedman, Darcy A et al. (2017) Comparison of the Availability and Cost of Foods Compatible With a Renal Diet Versus an Unrestricted Diet Using the Nutrition Environment Measures Survey. J Ren Nutr 27:183-186
Sehgal, Ashwini R (2017) Should Transplant Referral Be a Clinical Performance Measure? J Am Soc Nephrol 28:721-723
Sehgal, N K R; Sullivan, C; Figueroa, M et al. (2017) A Standardized Donor Designation Ratio to Assess the Performance of Driver's License Agencies. Transplant Proc 49:1211-1214
Whelton, Paul K; Einhorn, Paula T; Muntner, Paul et al. (2016) Research Needs to Improve Hypertension Treatment and Control in African Americans. Hypertension 68:1066-1072
Sehgal, N K R; Sullivan, C; Scallan, C et al. (2016) Is Signature Size Associated With Organ Donor Designation on Driver's Licenses? Transplant Proc 48:1911-5
Sehgal, N K R; Sullivan, C; Figueroa, M et al. (2016) Stability of Organ Donor Designations on Driver's Licenses. Transplant Proc 48:1907-10
Iqbal, Muhammad Nouman; Stott, Emily; Huml, Anne M et al. (2016) What's in a Name? Factors Associated with Documentation and Evaluation of Incidental Pulmonary Nodules. Ann Am Thorac Soc 13:1704-1711
Thornton, J Daryl; Sullivan, Catherine; Albert, Jeffrey M et al. (2016) Effects of a Video on Organ Donation Consent Among Primary Care Patients: A Randomized Controlled Trial. J Gen Intern Med 31:832-9
Rodrigue, James R; Paek, Matthew J; Schold, Jesse D et al. (2016) Predictors and Moderators of Educational Interventions to Increase the Likelihood of Potential Living Donors for Black Patients Awaiting Kidney Transplantation. J Racial Ethn Health Disparities :

Showing the most recent 10 out of 51 publications