SEKTC

ASCENT

2021 – present

Description

In 2014, a new kidney allocation system (KAS) was implemented with the goal of improving access to kidney transplantation by changing the calculation of waiting time. Early results of the policy suggested that racial disparities in waitlisting were eliminated; however, the policy change also led to an unintended consequence of an overall decrease in waitlisting. Given the significant role that clinical providers have in access to transplantation, it was important to understand the extent to which dialysis providers are educated about the impact of KAS on patient waitlisting and access to transplantation. 

Created in 2016, the Allocation System Changes for Equity in Kidney Transplantation (ASCENT) study was a hybrid type 1 effectiveness-implementation trial to evaluate the ASCENT intervention within 655 U.S. dialysis facilities with low waitlisting. The purpose of our study was to evaluate the effectiveness and implementation of a multi-level, multi-component intervention targeted to the staff at outpatient U.S. dialysis facilities within the lowest tertile for transplant waitlisting. The primary outcome of our effectiveness aim was to reduce racial disparities in waitlisting and increase access to these facilities’ national transplant waiting list. The secondary outcome was to increase dialysis provider knowledge of both transplant and the kidney allocation system policy changes, so they could effectively educate patients. The implementation science aim was to conduct a process evaluation of the implementation of ASCENT, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework. 

The multicomponent intervention was developed by a dissemination advisory board, which included stakeholders within the kidney health care system, including providers and patient advocates. The core components included: 

• Patient video: ~10-minute that highlighted the benefits of kidney transplant, dispelled common myths about transplant, and showcased patient stories on overcoming barriers to transplant 

• Staff video: ~10-minute targeted to dialysis staff, such as nephrologists, nurses, social workers and described the role of dialysis staff in the entire transplant process 
• Live and Recorded Webinar for Staff: ~30-minute video presenting the benefits of kidney transplant, changes to the kidney allocation policy, implications of the new policy on reducing racial disparities in waitlisting, and how staff can assist patients throughout the transplant process 
• Performance Feedback Report: Displayed facility-specific transplant access performance measures, such as facility-specific waitlisting and racial disparities in waitlisting, comparing the facility’s performance to national averages 

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All intervention materials are available on a unique website for patients and staff: www.ascenttotransplant.org