Impact of a Patient Education Program on Disparities in Kidney Transplant Evaluation

• Type of Material: Article
• Authors: Rachel Patzer, Emory University; Jennie P. Perryman, Emory University; Stephen Pastan, Emory University; Sandra Amaral, Childrens Hospital of Philadelphia; Julie Gazmararian, Emory University; Mitch Klein, Emory University; Nancy Kutner, Emory University; William M. McClellan, Emory University
• Language: English
• Date: 2012-04-01
• Publisher: American Society of Nephrology
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 by the American Society of Nephrology.
• Final Published Version (URL): http://dx.doi.org/10.2215/CJN.10071011
• Title of Journal or Parent Work: Clinical Journal of the American Society of Nephrology
• ISSN: 1555-9041
• Volume: 7
• Issue: 4
• Start Page: 648
• End Page: 655
• Grant/Funding Information: A portion of this work was presented at the American Society of Nephrology 2011 Annual Meeting, Philadelphia, Pennsylvania, November 8–13, 2011.
• Keywords: UNITED-STATES; POVERTY; AFRICAN-AMERICANS; DISEASE; Life Sciences & Biomedicine; ACCESS; Urology & Nephrology; RENAL-TRANSPLANTATION; RACIAL DISPARITIES; BARRIERS; HEALTH; Science & Technology
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Rehabilitation and Therapy; Health Sciences, Medicine and Surgery

Abstract

Background and objectives In 2007, the Emory Transplant Center (ETC) kidney transplant program implemented a required educational session for ESRD patients referred for renal transplant evaluation to increase patient awareness and decrease loss to follow-up. The purpose of this study was to evaluate the association of the ETC education program on completion of the transplant evaluation process. Design, setting, participants, & measurements Incident, adult ESRD patients referred from 2005 to 2008 were included. Patient data were abstracted from medical records and linked with data from the United States Renal Data System. Evaluation completion was compared by pre- and posteducational intervention groups in binomial regression models accounting for temporal confounding. Results A total of 1126 adult ESRD patients were examined in two transplant evaluation eras (75% pre- and 25% postintervention). One-year evaluation completion was higher in the post- versus preintervention group (80.4% versus 44.7%, P<0.0001). In adjusted analyses controlling for time trends, the adjusted probability of evaluation completion at 1 year was higher among the intervention versus nonintervention group (risk ratio=1.38, 95% confidence interval=1.12-1.71). The effect of the intervention was stronger among black patients and those patients living in poor neighborhoods (likelihood ratio test for interaction, P<0.05). Conclusions Standardizing transplant education may help reduce some of the racial and socioeconomic disparities observed in kidney transplantation.