Kidney Disorders
Conditions
Keywords
Transplantation Surgery, Nephrology, Organ and Tissue Transplantation, End stage renal disease (ESRD)
Brief summary
The purpose of the current study is to test a systems-level approach to disseminate a multicomponent, multilevel intervention consisting of educational materials about transplantation and the new kidney allocation system targeting dialysis facility medical directors, staff, and patients. Roughly 750 dialysis facilities in up to 18 End Stage Renal Disease Network regions across the United States will be randomized to receive intervention materials. The overall goal of the study is to extend the influence of the national allocation policy in reducing disparities in early steps in kidney transplant access.
Detailed description
The purpose of the Allocation System for Changes in Equity in kidNey Transplantation (ASCENT) study is to test a systems-level approach to disseminate a multi-component intervention consisting of in the era of the new national kidney allocation policy and educational materials targeting dialysis facility medical directors, staff, and patients. The investigators will randomize \ 750 dialysis facilities in up to 18 End Stage Renal Disease Network regions across the United States, where approximately half of facilities will receive the intervention materials and half will receive an informational brochure. This pragmatic, clinical effectiveness-implementation study will test the effectiveness of the multicomponent, multilevel interventions consisting of a tailored, facility-specific transplant and disparity performance report, educational videos for staff and dialysis patients, and an educational webinar for dialysis facility medical directors and staff.
Interventions
OTHERPerformance Feedback Reports
Medical directors will be provided performance feedback reports that are a summary of clinical performance of transplant and racial disparity performance over a period of time aimed at providing information to allow them to assess and adjust their transplant performance. The report will emphasize tailored facility-specific information on the mean time on dialysis for patients in that facility and transplant access performance measures, such as wait listing and transplantation, including the magnitude of racial disparity, detailing when a facility is performing below the national or regional average.
OTHEREducational Video for Staff
Dialysis facility staff will watch a \ 10 minute educational video that describes the role of dialysis staff in improving transplant access, the new kidney allocation policy, and how the new policy impacts minority patients and those on dialysis for a substantial period of time.
OTHEREducational Video for Patients
Dialysis facilities will receive a \ 10 minute educational video targeted to dialysis patients to explain the transplant process and allocation policy.
OTHEREducational Webinar
Education for medical directors and facility staff about the kidney allocation policy will be discussed in a webinar and information will be hosted on a website for participants to access. The seminar will be roughly 45 minutes, and continuing medical education (CME) credits will be offered.
OTHERStandard Care
Dialysis facilities will conduct standard or usual care and education regarding transplantation.
OTHERUnited Network for Organ Sharing (UNOS) Pamphlet
Dialysis facility staff will be provided an educational pamphlet detailing the changes in the new kidney allocation policy .
Sponsors
National Institutes of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Emory University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Dialysis facilities with at least 25 patients composed of at least 10% African American and 10% Caucasian
Exclusion criteria
* Dialysis facilities with wait listing rates above the national tertile
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Black and White Prevalent Patients Waitlisted During the Post-Intervention Time Period | Post-intervention (the twelve month period after the intervention) | Waitlisting disparity is assessed as the adjusted mean proportion of Black versus White prevalent patients waitlisted for kidney transplantation at study dialysis facilities during the post-intervention period. Mean proportions were adjusted for time and facility-level random effects. |
| Proportion of Black and White Incident Patients Waitlisted | Baseline (the twelve month period prior to the intervention), Post-intervention (the twelve month period after the intervention) | The adjusted mean proportions of Black versus White incident patients waitlisted for kidney transplantation at study dialysis facilities, at the baseline and post-intervention follow-up assessments, were calculated. Mean proportions were adjusted for time and facility-level random effects. |
| Proportion of Prevalent Patients Waitlisted During the Baseline Period | Baseline (the twelve month period prior to the intervention) | The adjusted mean proportions of prevalent patients waitlisted for kidney transplantation at study dialysis facilities during the baseline time period were calculated. Mean proportions were adjusted for time and facility-level random effects. |
| Proportion of Prevalent Patients Waitlisted During the Post-Intervention Time Period | Post-intervention (the twelve month period after the intervention) | The adjusted mean proportions of prevalent patients waitlisted for kidney transplantation at study dialysis facilities during the post-intervention period were calculated. Mean proportions were adjusted for time and facility-level random effects. |
| Proportion of Black and White Prevalent Patients Waitlisted During the Baseline Period | Baseline (the twelve month period prior to the intervention) | Waitlisting disparity is assessed as the adjusted mean proportion of Black versus White prevalent patients waitlisted for kidney transplantation at study dialysis facilities during the baseline time period. Mean proportions were adjusted for time and facility-level random effects. |
| Proportion of Incident Patients Waitlisted | Baseline (the twelve month period prior to the intervention), Post-intervention (the twelve month period after the intervention) | The adjusted mean proportions of incident (new) patients waitlisted for kidney transplantation at study dialysis facilities, at the baseline and post-intervention time periods, were calculated. Incident patients are those who initiated dialysis treatment at study facilities during one of the study time periods. Mean proportions were adjusted for time and facility-level random effects. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Facilities With Increases or No Change/Decreases in Staff Training | Baseline, Immediately Post-intervention (3 months after the start of the intervention) | Staff training about kidney transplant and the allocation system was assessed among dialysis facility medical directors or nurse managers by asking what proportion of staff have you trained regarding the new kidney allocations system? The staff training score was based on facility-level average percent and used a scale of 0 = 0% of staff trained, 1 = 1-20% of staff trained, 2 = 21-40% of staff trained, 3 = 41-60% of staff trained, 4 = 61-80% of staff trained, and 5 = 81-100% of staff trained. Facilities were grouped as either having an increase in the percentage of staff who were trained about KAS, or had no change or a decrease in the percentage of staff trained between the baseline and post-intervention follow-up at 3 months. |
| Percentage of Facilities With Increases or No Change/Decreases in Patient Education | Baseline, Immediately Post-intervention (3 months after the start of the intervention) | Patient education about kidney transplant and the allocation system was assessed among dialysis facility medical directors or nurse managers by asking what proportion of patients in this specific facility have you or your staff educated about kidney transplantation? The patient education score was based on facility-level average percent and recorded as ordinal responses scored on a scale of 0 = 0% of patients educated, 1 = 1-20% of patients educated, 2 = 21-40% of patients educated, 3 = 41-60% of patients educated, 4 = 61-80% of patients educated, and 5 = 81-100% of patients educated. Facilities were grouped as either having an increase in the percentage of patients educated about KAS, or had no change or a decrease in the percentage of patients educated between the baseline and post-intervention follow-up at 3 months. |
| Percentage of Facilities With Increases or No Change/Decreases in Intent to Refer Patients for Kidney Transplantation | Immediately Post-intervention (3 months after the start of the intervention) | Change in referral practices were measured by asking dialysis facility medical directors or nurse managers about the estimated number of patients where were referred for kidney transplantation in that facility. The medical director or nurse manager was asked since the beginning of the ASCENT quality improvement project (about 3 months ago), have you been referring more or fewer patients? Possible responses were: more, same, fewer, or unsure. Facilities were grouped as either having an increase in the number of patients referred for transplant, or had no change or a decrease in the proportion of patients referred for transplant. |
| Knowledge About the Kidney Allocation System | Baseline, Immediately Post-intervention (3 months after the start of the intervention) | Knowledge about the kidney allocation system was assessed using a survey among dialysis facility medical directors or nurse managers. The survey measured provider knowledge of Kidney Allocation System (KAS) and transplantation using a cumulative knowledge score ranging from 0 to 5, where 0 = least knowledge and 5 = highest level of knowledge (higher scores are preferable, indicating greater knowledge). |
Countries
United States
Participant flow
Recruitment details
Recruitment of dialysis facilities began in September 2016. Data collection via surveillance data from patients of the dialysis facilities occurred retroactively for both study periods. The baseline period includes patients seen at dialysis facilities during January 2016 to December 2016, while the follow-up period includes patients seen at dialysis facilities during April 2017 to March 2018. Data collection from surveillance data concluded on August 2, 2019.
Pre-assignment details
Information on patients seen during the study periods was obtained via surveillance data from study dialysis facilities. Only minimal information was collected about dialysis facility patients, thus, the total number of discrete patients is unknown as individuals could have been a patient of a dialysis facility during both study periods.
Participants by arm
| Arm | Count |
|---|---|
| ASCENT Intervention ASCENT is a multi-component educational intervention delivered to dialysis facilities. End Stage Renal Disease (ESRD) facilities received performance feedback reports containing facility specific data, an educational webinar for dialysis facility medical directors and staff, an educational video for patients and staff; and the United Network for Organ Sharing (UNOS) pamphlet for dialysis facility staff detailing the changes in the new kidney allocation policy. The study intervention period occurred January 2017 through March 2017. | 28,246 |
| ASCENT Intervention ASCENT is a multi-component educational intervention delivered to dialysis facilities. End Stage Renal Disease (ESRD) facilities received performance feedback reports containing facility specific data, an educational webinar for dialysis facility medical directors and staff, an educational video for patients and staff; and the United Network for Organ Sharing (UNOS) pamphlet for dialysis facility staff detailing the changes in the new kidney allocation policy. The study intervention period occurred January 2017 through March 2017. | 329 |
| Standard Care Plus Educational Pamphlet Dialysis facilities randomized to the control study arm delivered standard or usual care and education regarding transplantation. Dialysis facility staff were provided the United Network for Organ Sharing (UNOS) educational pamphlet detailing the changes in the new kidney allocation policy. The study intervention period occurred January 2017 through March 2017. | 28,086 |
| Standard Care Plus Educational Pamphlet Dialysis facilities randomized to the control study arm delivered standard or usual care and education regarding transplantation. Dialysis facility staff were provided the United Network for Organ Sharing (UNOS) educational pamphlet detailing the changes in the new kidney allocation policy. The study intervention period occurred January 2017 through March 2017. | 320 |
| Total | 56,981 |
Baseline characteristics
| Characteristic | ASCENT Intervention | Total | Standard Care Plus Educational Pamphlet |
|---|---|---|---|
| Age, Continuous | 59.3 years STANDARD_DEVIATION 15.6 | 59.3 years STANDARD_DEVIATION 15.6 | 59.2 years STANDARD_DEVIATION 15.6 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4270 Participants | 7641 Participants | 3371 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 23976 Participants | 48691 Participants | 24715 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 145 Participants | 238 Participants | 93 Participants |
| Race (NIH/OMB) Asian | 725 Participants | 1214 Participants | 489 Participants |
| Race (NIH/OMB) Black or African American | 10821 Participants | 22913 Participants | 12092 Participants |
| Race (NIH/OMB) More than one race | 59 Participants | 117 Participants | 58 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 226 Participants | 402 Participants | 176 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 16270 Participants | 31448 Participants | 15178 Participants |
| Region of Enrollment United States | 28246 participants | 56332 participants | 28086 participants |
| Sex: Female, Male Female | 12432 Participants | 25121 Participants | 12689 Participants |
| Sex: Female, Male Male | 15814 Participants | 31211 Participants | 15397 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Proportion of Black and White Incident Patients Waitlisted
The adjusted mean proportions of Black versus White incident patients waitlisted for kidney transplantation at study dialysis facilities, at the baseline and post-intervention follow-up assessments, were calculated. Mean proportions were adjusted for time and facility-level random effects.
Time frame: Baseline (the twelve month period prior to the intervention), Post-intervention (the twelve month period after the intervention)
Population: This analysis included incident patients among the facilities included in the intention-to-treat analysis. Incident patients participated in either the baseline or post-intervention time periods. The overall number of participants analyzed is the sum of incident patients in facilities randomized to each study arm at the baseline and post-intervention assessment periods.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| ASCENT Intervention | Proportion of Black and White Incident Patients Waitlisted | Black patients on the waitlist the the baseline time period | 0.87 adjusted mean proportion of patients |
| ASCENT Intervention | Proportion of Black and White Incident Patients Waitlisted | Black patients on the waitlist during the post-intervention time period | 1.07 adjusted mean proportion of patients |
| ASCENT Intervention | Proportion of Black and White Incident Patients Waitlisted | White patients on the waitlist during the baseline time period | 1.54 adjusted mean proportion of patients |
| ASCENT Intervention | Proportion of Black and White Incident Patients Waitlisted | White patients on the waitlist during the post-intervention time period | 1.27 adjusted mean proportion of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Black and White Incident Patients Waitlisted | White patients on the waitlist during the post-intervention time period | 1.37 adjusted mean proportion of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Black and White Incident Patients Waitlisted | Black patients on the waitlist the the baseline time period | 1.12 adjusted mean proportion of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Black and White Incident Patients Waitlisted | White patients on the waitlist during the baseline time period | 1.42 adjusted mean proportion of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Black and White Incident Patients Waitlisted | Black patients on the waitlist during the post-intervention time period | 1.15 adjusted mean proportion of patients |
Primary
Proportion of Black and White Prevalent Patients Waitlisted During the Baseline Period
Waitlisting disparity is assessed as the adjusted mean proportion of Black versus White prevalent patients waitlisted for kidney transplantation at study dialysis facilities during the baseline time period. Mean proportions were adjusted for time and facility-level random effects.
Time frame: Baseline (the twelve month period prior to the intervention)
Population: This analysis includes Black and White patients of study facilities during the baseline (pre-intervention) time period.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| ASCENT Intervention | Proportion of Black and White Prevalent Patients Waitlisted During the Baseline Period | Black patients on the waitlist during the baseline time period | 2.52 adjusted mean percentage of patients |
| ASCENT Intervention | Proportion of Black and White Prevalent Patients Waitlisted During the Baseline Period | White patients on the waitlist during the baseline time period | 2.66 adjusted mean percentage of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Black and White Prevalent Patients Waitlisted During the Baseline Period | Black patients on the waitlist during the baseline time period | 2.71 adjusted mean percentage of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Black and White Prevalent Patients Waitlisted During the Baseline Period | White patients on the waitlist during the baseline time period | 2.67 adjusted mean percentage of patients |
Primary
Proportion of Black and White Prevalent Patients Waitlisted During the Post-Intervention Time Period
Waitlisting disparity is assessed as the adjusted mean proportion of Black versus White prevalent patients waitlisted for kidney transplantation at study dialysis facilities during the post-intervention period. Mean proportions were adjusted for time and facility-level random effects.
Time frame: Post-intervention (the twelve month period after the intervention)
Population: This analysis includes Black and White patients of study facilities during the post-intervention time period.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| ASCENT Intervention | Proportion of Black and White Prevalent Patients Waitlisted During the Post-Intervention Time Period | Black patients on the waitlist during the post-intervention time period | 2.78 adjusted mean percentage of patients |
| ASCENT Intervention | Proportion of Black and White Prevalent Patients Waitlisted During the Post-Intervention Time Period | White patients on the waitlist during the post-intervention time period | 2.69 adjusted mean percentage of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Black and White Prevalent Patients Waitlisted During the Post-Intervention Time Period | Black patients on the waitlist during the post-intervention time period | 2.56 adjusted mean percentage of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Black and White Prevalent Patients Waitlisted During the Post-Intervention Time Period | White patients on the waitlist during the post-intervention time period | 2.51 adjusted mean percentage of patients |
Primary
Proportion of Incident Patients Waitlisted
The adjusted mean proportions of incident (new) patients waitlisted for kidney transplantation at study dialysis facilities, at the baseline and post-intervention time periods, were calculated. Incident patients are those who initiated dialysis treatment at study facilities during one of the study time periods. Mean proportions were adjusted for time and facility-level random effects.
Time frame: Baseline (the twelve month period prior to the intervention), Post-intervention (the twelve month period after the intervention)
Population: This analysis included incident patients among the facilities included in the intention-to-treat analysis. Incident patients participated in either the baseline or post-intervention assessment. The overall number of participants analyzed is the sum of incident patients in facilities randomized to each study arm at the baseline and post-intervention periods.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| ASCENT Intervention | Proportion of Incident Patients Waitlisted | Patients on the waitlist during the baseline time period | 1.39 adjusted mean proportion of patients |
| ASCENT Intervention | Proportion of Incident Patients Waitlisted | Patients on the waitlist during the post-intervention time period | 1.25 adjusted mean proportion of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Incident Patients Waitlisted | Patients on the waitlist during the baseline time period | 1.33 adjusted mean proportion of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Incident Patients Waitlisted | Patients on the waitlist during the post-intervention time period | 1.30 adjusted mean proportion of patients |
Primary
Proportion of Prevalent Patients Waitlisted During the Baseline Period
The adjusted mean proportions of prevalent patients waitlisted for kidney transplantation at study dialysis facilities during the baseline time period were calculated. Mean proportions were adjusted for time and facility-level random effects.
Time frame: Baseline (the twelve month period prior to the intervention)
Population: This analysis includes patients of the study facilities during the baseline (pre-intervention) time period.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| ASCENT Intervention | Proportion of Prevalent Patients Waitlisted During the Baseline Period | 2.68 adjusted mean proportion of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Prevalent Patients Waitlisted During the Baseline Period | 2.72 adjusted mean proportion of patients |
Primary
Proportion of Prevalent Patients Waitlisted During the Post-Intervention Time Period
The adjusted mean proportions of prevalent patients waitlisted for kidney transplantation at study dialysis facilities during the post-intervention period were calculated. Mean proportions were adjusted for time and facility-level random effects.
Time frame: Post-intervention (the twelve month period after the intervention)
Population: This analysis includes patients of study facilities during the post-intervention time period.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| ASCENT Intervention | Proportion of Prevalent Patients Waitlisted During the Post-Intervention Time Period | 2.75 adjusted mean proportion of patients |
| Standard Care Plus Educational Pamphlet | Proportion of Prevalent Patients Waitlisted During the Post-Intervention Time Period | 2.56 adjusted mean proportion of patients |
Secondary
Knowledge About the Kidney Allocation System
Knowledge about the kidney allocation system was assessed using a survey among dialysis facility medical directors or nurse managers. The survey measured provider knowledge of Kidney Allocation System (KAS) and transplantation using a cumulative knowledge score ranging from 0 to 5, where 0 = least knowledge and 5 = highest level of knowledge (higher scores are preferable, indicating greater knowledge).
Time frame: Baseline, Immediately Post-intervention (3 months after the start of the intervention)
Population: This analysis includes dialysis facility staff who completed this question at the baseline and post-intervention time points. One staff member per facility completed the facility surveys at each study time point. During the course of the study some facilities were lost to follow-up and some staff members did not respond to all questions at the baseline and post-intervention assessments.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| ASCENT Intervention | Knowledge About the Kidney Allocation System | Baseline assessment | 2.31 score on a scale | Standard Deviation 1.46 |
| ASCENT Intervention | Knowledge About the Kidney Allocation System | Post-intervention assessment | 3.41 score on a scale | Standard Deviation 1.28 |
| Standard Care Plus Educational Pamphlet | Knowledge About the Kidney Allocation System | Baseline assessment | 2.45 score on a scale | Standard Deviation 1.43 |
| Standard Care Plus Educational Pamphlet | Knowledge About the Kidney Allocation System | Post-intervention assessment | 3.07 score on a scale | Standard Deviation 1.24 |
Secondary
Percentage of Facilities With Increases or No Change/Decreases in Intent to Refer Patients for Kidney Transplantation
Change in referral practices were measured by asking dialysis facility medical directors or nurse managers about the estimated number of patients where were referred for kidney transplantation in that facility. The medical director or nurse manager was asked since the beginning of the ASCENT quality improvement project (about 3 months ago), have you been referring more or fewer patients? Possible responses were: more, same, fewer, or unsure. Facilities were grouped as either having an increase in the number of patients referred for transplant, or had no change or a decrease in the proportion of patients referred for transplant.
Time frame: Immediately Post-intervention (3 months after the start of the intervention)
Population: This analysis includes dialysis facility staff who completed this question at the baseline and post-intervention time points. One staff member per facility completed the facility surveys at each study time point. During the course of the study some facilities were lost to follow-up and some staff members did not respond to all questions at the baseline and post-intervention assessments.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| ASCENT Intervention | Percentage of Facilities With Increases or No Change/Decreases in Intent to Refer Patients for Kidney Transplantation | Facilities with same or decreased intent to refer for transplant from baseline to post-intervention | 73 Percentage of facilities |
| ASCENT Intervention | Percentage of Facilities With Increases or No Change/Decreases in Intent to Refer Patients for Kidney Transplantation | Facilities with increased intent to refer for transplant from baseline to post-intervention | 27 Percentage of facilities |
| Standard Care Plus Educational Pamphlet | Percentage of Facilities With Increases or No Change/Decreases in Intent to Refer Patients for Kidney Transplantation | Facilities with increased intent to refer for transplant from baseline to post-intervention | 23 Percentage of facilities |
| Standard Care Plus Educational Pamphlet | Percentage of Facilities With Increases or No Change/Decreases in Intent to Refer Patients for Kidney Transplantation | Facilities with same or decreased intent to refer for transplant from baseline to post-intervention | 77 Percentage of facilities |
Secondary
Percentage of Facilities With Increases or No Change/Decreases in Patient Education
Patient education about kidney transplant and the allocation system was assessed among dialysis facility medical directors or nurse managers by asking what proportion of patients in this specific facility have you or your staff educated about kidney transplantation? The patient education score was based on facility-level average percent and recorded as ordinal responses scored on a scale of 0 = 0% of patients educated, 1 = 1-20% of patients educated, 2 = 21-40% of patients educated, 3 = 41-60% of patients educated, 4 = 61-80% of patients educated, and 5 = 81-100% of patients educated. Facilities were grouped as either having an increase in the percentage of patients educated about KAS, or had no change or a decrease in the percentage of patients educated between the baseline and post-intervention follow-up at 3 months.
Time frame: Baseline, Immediately Post-intervention (3 months after the start of the intervention)
Population: This analysis includes dialysis facility staff who completed this question at the baseline and post-intervention time points. One staff member per facility completed the facility surveys at each study time point. During the course of the study some facilities were lost to follow-up and some staff members did not respond to all questions at the baseline and post-intervention assessments.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| ASCENT Intervention | Percentage of Facilities With Increases or No Change/Decreases in Patient Education | Facilities with increases in patient education from baseline to post-intervention | 46 Percentage of facilities |
| ASCENT Intervention | Percentage of Facilities With Increases or No Change/Decreases in Patient Education | Facilities with no change or a decrease in patient education from baseline to post-intervention | 54 Percentage of facilities |
| Standard Care Plus Educational Pamphlet | Percentage of Facilities With Increases or No Change/Decreases in Patient Education | Facilities with increases in patient education from baseline to post-intervention | 54 Percentage of facilities |
| Standard Care Plus Educational Pamphlet | Percentage of Facilities With Increases or No Change/Decreases in Patient Education | Facilities with no change or a decrease in patient education from baseline to post-intervention | 46 Percentage of facilities |
Secondary
Percentage of Facilities With Increases or No Change/Decreases in Staff Training
Staff training about kidney transplant and the allocation system was assessed among dialysis facility medical directors or nurse managers by asking what proportion of staff have you trained regarding the new kidney allocations system? The staff training score was based on facility-level average percent and used a scale of 0 = 0% of staff trained, 1 = 1-20% of staff trained, 2 = 21-40% of staff trained, 3 = 41-60% of staff trained, 4 = 61-80% of staff trained, and 5 = 81-100% of staff trained. Facilities were grouped as either having an increase in the percentage of staff who were trained about KAS, or had no change or a decrease in the percentage of staff trained between the baseline and post-intervention follow-up at 3 months.
Time frame: Baseline, Immediately Post-intervention (3 months after the start of the intervention)
Population: This analysis includes dialysis facility staff who completed this question at the baseline and post-intervention time points. One staff member per facility completed the facility surveys at each study time point. During the course of the study some facilities were lost to follow-up and some staff members did not respond to all questions at the baseline and post-intervention assessments.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| ASCENT Intervention | Percentage of Facilities With Increases or No Change/Decreases in Staff Training | Facilities with increases in staff training from baseline to post-intervention | 76 Percentage of facilities |
| ASCENT Intervention | Percentage of Facilities With Increases or No Change/Decreases in Staff Training | Facilities with no change or a decrease in staff training from baseline to post-intervention | 24 Percentage of facilities |
| Standard Care Plus Educational Pamphlet | Percentage of Facilities With Increases or No Change/Decreases in Staff Training | Facilities with increases in staff training from baseline to post-intervention | 72 Percentage of facilities |
| Standard Care Plus Educational Pamphlet | Percentage of Facilities With Increases or No Change/Decreases in Staff Training | Facilities with no change or a decrease in staff training from baseline to post-intervention | 28 Percentage of facilities |