Effect of the ASCENT Intervention to Increase Knowledge of Kidney Allocation Policy Changes Among Dialysis Providers

• Type of Material: Article
• Authors: Wairimu Magua, Emory University; Mohua Basu, Emory University; Stephen Pastan, Emory University; Joyce J. Kim, Emory University; Kayla Smith, Emory University; Jennifer Gander, Kaiser Permanente Georgia; Sumit Mohan, Columbia University; Ngoc-Cam Escoffery, Emory University; Laura Plantinga, Emory University; Taylor Melanson, Emory University; Michael D. Garber, Emory University; Rachel Patzer, Emory University
• Language: English
• Date: 2020-09-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Final Published Version
• Copyright Statement: © 2020 Published by Elsevier, Inc., on behalf of the International Society of Nephrology.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ekir.2020.06.027
• Title of Journal or Parent Work: KIDNEY INTERNATIONAL REPORTS
• Volume: 5
• Issue: 9
• Start Page: 1422
• End Page: 1431
• Grant/Funding Information: This work was supported by National Institute on Minority Health and Health Disparities Grant No. R01MD010290. The full trial protocol is available in Kidney International Reports. ClinicalTrials.gov identifier: NCT02879812.
• Keywords: RANDOMIZED-TRIAL; effectiveness-implementation trial; RACIAL DISPARITIES; Urology & Nephrology; dialysis; UNITED-STATES; health system intervention; MULTIPLE IMPUTATION; kidney transplantation; Science & Technology; IMPROVEMENT EFFORTS; kidney allocation system; pragmatic trial; QUALITY-OF-LIFE; TRANSPLANTATION; EDUCATIONAL INTERVENTIONS; CARE PROVIDERS; Life Sciences & Biomedicine; TERM IMPACT
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Introduction: The Allocation System Changes for Equity in Kidney Transplantation (ASCENT) trial was a cluster-randomized pragmatic, effectiveness-implementation study designed to test whether a multicomponent educational intervention targeting leadership, clinic staff, and patients in dialysis facilities improved knowledge and awareness of the 2014 Kidney Allocation System (KAS) change. Methods: Participants included 690 dialysis facility medical directors, nephrologists, social workers, and other staff within 655 US dialysis facilities, with 51% (n = 334) in the intervention group and 49% (n = 321) in the control group. Intervention activities included a webinar targeting medical directors and facility staff, an approximately 10-minute educational video targeting dialysis staff, an approximately 10-minute educational video targeting patients, and a facility-specific audit and feedback report of transplant performance. The control group received a standard United Network for Organ Sharing brochure. Provider knowledge was a secondary outcome of the ASCENT trial and the primary outcome of this study; knowledge was assessed as a cumulative score on a 5-point Likert scale (higher score = greater knowledge). Intention-to-treat analysis was used. Results: At baseline, nonintervention providers had a higher mean knowledge score (mean ± SD, 2.45 ± 1.43) than intervention providers (mean ± SD, 2.31 ± 1.46). After 3 months, the average knowledge score was slightly higher in the intervention (mean ± SD, 3.14 ± 1.28) versus nonintervention providers (mean ± SD, 3.07 ± 1.24), and the estimated mean difference in knowledge scores between the groups at follow-up minus the mean difference at baseline was 0.25 (95% confidence interval [CI], 0.11–0.48; P = 0.039). The effect size (0.41) was low to moderate. Conclusion: Dialysis facility provider education could help extend the impact of a national policy change in organ allocation.