Mohua Basu1, Lisa Petgrave-Nelson2, Kayla D Smith1,2, Jennie P Perryman2, Kevin Clark2, Stephen O Pastan2,3, Thomas C Pearson1,2, Christian P Larsen1,2, Sudeshna Paul4, Rachel E Patzer5,2,6. 1. Division of Transplantation, Department of Surgery and. 2. Emory Transplant Center, Atlanta, Georgia; and. 3. Renal Division, Emory University School of Medicine, Atlanta, Georgia. 4. Office of Nursing Research, Nell Hodgson Woodruff School of Nursing and. 5. Division of Transplantation, Department of Surgery and rpatzer@emory.edu. 6. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Abstract
BACKGROUND AND OBJECTIVES: Barriers exist in access to kidney transplantation, where minority and patients with low socioeconomic status are less likely to complete transplant evaluation. The purpose of this study was to examine the effectiveness of a transplant center-based patient navigator in helping patients at high risk of dropping out of the transplant evaluation process access the kidney transplant waiting list. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS: We conducted a randomized, controlled trial of 401 patients (n=196 intervention and n=205 control) referred for kidney transplant evaluation (January 2013 to August 2014; followed through May 2016) at a single center. A trained navigator assisted intervention participants from referral to waitlisting decision to increase waitlisting (primary outcome) and decrease time from referral to waitlisting (secondary outcome). Time-dependent Cox proportional hazards models were used to determine differences in waitlisting between intervention and control patients. RESULTS: At study end, waitlisting was not significantly different among intervention (32%) versus control (26%) patients overall (P=0.17), and time from referral to waitlisting was 126 days longer for intervention patients. However, the effectiveness of the navigator varied from early (<500 days from referral) to late (≥500 days) follow-up. Although no difference in waitlisting was observed among intervention (50%) versus control (50%) patients in the early period (hazard ratio, 1.03; 95% confidence interval, 0.69 to 1.53), intervention patients were 3.3 times more likely to be waitlisted after 500 days (75% versus 25%; hazard ratio, 3.31; 95% confidence interval, 1.20 to 9.12). There were no significant differences in intervention versus control patients who started evaluation (85% versus 79%; P=0.11) or completed evaluation (58% versus 51%; P=0.14); however, intervention patients had more living donor inquiries (18% versus 10%; P=0.03). CONCLUSIONS: A transplant center-based navigator targeting disadvantaged patients improved waitlisting but not until after 500 days of follow-up. However, the absolute effect was relatively small.
RCT Entities:
BACKGROUND AND OBJECTIVES: Barriers exist in access to kidney transplantation, where minority and patients with low socioeconomic status are less likely to complete transplant evaluation. The purpose of this study was to examine the effectiveness of a transplant center-based patient navigator in helping patients at high risk of dropping out of the transplant evaluation process access the kidney transplant waiting list. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS: We conducted a randomized, controlled trial of 401 patients (n=196 intervention and n=205 control) referred for kidney transplant evaluation (January 2013 to August 2014; followed through May 2016) at a single center. A trained navigator assisted intervention participants from referral to waitlisting decision to increase waitlisting (primary outcome) and decrease time from referral to waitlisting (secondary outcome). Time-dependent Cox proportional hazards models were used to determine differences in waitlisting between intervention and control patients. RESULTS: At study end, waitlisting was not significantly different among intervention (32%) versus control (26%) patients overall (P=0.17), and time from referral to waitlisting was 126 days longer for intervention patients. However, the effectiveness of the navigator varied from early (<500 days from referral) to late (≥500 days) follow-up. Although no difference in waitlisting was observed among intervention (50%) versus control (50%) patients in the early period (hazard ratio, 1.03; 95% confidence interval, 0.69 to 1.53), intervention patients were 3.3 times more likely to be waitlisted after 500 days (75% versus 25%; hazard ratio, 3.31; 95% confidence interval, 1.20 to 9.12). There were no significant differences in intervention versus control patients who started evaluation (85% versus 79%; P=0.11) or completed evaluation (58% versus 51%; P=0.14); however, intervention patients had more living donor inquiries (18% versus 10%; P=0.03). CONCLUSIONS: A transplant center-based navigator targeting disadvantaged patients improved waitlisting but not until after 500 days of follow-up. However, the absolute effect was relatively small.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: D LaPointe Rudow; R Hays; P Baliga; D J Cohen; M Cooper; G M Danovitch; M A Dew; E J Gordon; D A Mandelbrot; S McGuire; J Milton; D R Moore; M Morgievich; J D Schold; D L Segev; D Serur; R W Steiner; J C Tan; A D Waterman; E Y Zavala; J R Rodrigue Journal: Am J Transplant Date: 2015-02-03 Impact factor: 8.086
Authors: Alexander S Goldfarb-Rumyantzev; Gurprataap S Sandhu; Bradley Baird; Anna Barenbaum; Joo Heung Yoon; Noelle Dimitri; James K Koford; Fuad Shihab Journal: Clin Transplant Date: 2010-12-27 Impact factor: 2.863
Authors: Jesse D Schold; Jon A Gregg; Jeffrey S Harman; Allyson G Hall; Pamela R Patton; Herwig-Ulf Meier-Kriesche Journal: Clin J Am Soc Nephrol Date: 2011-05-19 Impact factor: 8.237
Authors: Michael L Steinberg; Allen Fremont; David C Khan; David Huang; Herschel Knapp; Deborah Karaman; Nell Forge; Keith Andre; Lisa M Chaiken; Oscar E Streeter Journal: Cancer Date: 2006-12-01 Impact factor: 6.860
Authors: Peter C Raich; Elizabeth M Whitley; William Thorland; Patricia Valverde; Diane Fairclough Journal: Cancer Epidemiol Biomarkers Prev Date: 2012-10 Impact factor: 4.254
Authors: Rachel E Patzer; Sandra Amaral; Haimanot Wasse; Nataliya Volkova; David Kleinbaum; William M McClellan Journal: J Am Soc Nephrol Date: 2009-04-01 Impact factor: 10.121
Authors: Catherine M Sullivan; Kitty V Barnswell; Kate Greenway; Cindy M Kamps; Derrick Wilson; Jeffrey M Albert; Jacqueline Dolata; Anne Huml; Julie A Pencak; John T Ducker; Roberto Gedaly; Christopher M Jones; Todd Pesavento; Ashwini R Sehgal Journal: Clin J Am Soc Nephrol Date: 2018-08-22 Impact factor: 8.237
Authors: Karly A Murphy; John W Jackson; Tanjala S Purnell; Ashton A Shaffer; Christine E Haugen; Nadia M Chu; Deidra C Crews; Silas P Norman; Dorry L Segev; Mara A McAdams-DeMarco Journal: Clin J Am Soc Nephrol Date: 2020-05-07 Impact factor: 8.237
Authors: Fatima Warsame; Christine E Haugen; Hao Ying; Jacqueline M Garonzik-Wang; Niraj M Desai; Rasheeda K Hall; Rekha Kambhampati; Deidra C Crews; Tanjala S Purnell; Dorry L Segev; Mara A McAdams-DeMarco Journal: Am J Transplant Date: 2018-08-16 Impact factor: 8.086
Authors: Hannah Wesselman; Christopher Graham Ford; Yuridia Leyva; Xingyuan Li; Chung-Chou H Chang; Mary Amanda Dew; Kellee Kendall; Emilee Croswell; John R Pleis; Yue Harn Ng; Mark L Unruh; Ron Shapiro; Larissa Myaskovsky Journal: Clin J Am Soc Nephrol Date: 2021-01-28 Impact factor: 8.237
Authors: Amy D Waterman; John D Peipert; Yujie Cui; Jennifer L Beaumont; Andrea Paiva; Amanda F Lipsey; Crystal S Anderson; Mark L Robbins Journal: Am J Transplant Date: 2020-09-15 Impact factor: 8.086