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Hahn EE, Ritzwoller DP, Munoz-Plaza CE, Gander J, Kushi LH, McMullen C, Oshiro C, Roblin DW, Wernli KJ, Staab J. Incidence and Survival for Patients Diagnosed With Breast, Colorectal, and Lung Cancer in an Integrated System. Perm J 2023; 27:129-135. [PMID: 37724894 PMCID: PMC10723094 DOI: 10.7812/tpp/23.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Documenting trends in cancer incidence and survival is a national priority. This study estimated age- and sex-adjusted incidence and 5-year relative survival among patients with cancer diagnosed within Kaiser Permanente compared to Surveillance, Epidemiology, and End Results (SEER) estimates. METHODS The cohort included Kaiser Permanente health plan members diagnosed with breast (BC), colorectal (CRC), or lung cancer (LC) between January 1, 1999 and December 31, 2018. Incidence was computed as age-adjusted rates per 100,000 member-years. SEER*Stat was used to compute 5-year relative survival. RESULTS Kaiser Permanente BC incidence rates were persistently higher than SEER from 2004 (126.5 [95% confidence interval (CI) = 123.2-129.9] vs 122.6 [95% CI = 121.3-123.2]) through 2013 (132.06 [95% CI = 129.5-135.7] vs 126.7 [95% CI = 125.9-127.5]). Kaiser Permanente CRC and LC incidence rates were lower than SEER for all years except 2008, showing a spike in CRC incidence (51.5 [95% CI = 49.9-53.0] vs 46.1 [95% CI = 45.7-46.4]). Kaiser Permanente BC, CRC, and LC survival estimates for all stages were higher than SEER. CONCLUSIONS Incidence rates for all-stage and localized-stage BC were consistently higher for Kaiser Permanente than for SEER. CRC and LC rates were lower. Kaiser Permanente survival rates were consistently higher than for SEER. The strengths of these findings are associated with the ability to capture "gold-standard" cancer registry data on defined Kaiser Permanente populations. However, findings should be interpreted cautiously given differences in the underlying populations and secular and regional differences between Kaiser Permanente and SEER. The Kaiser Permanente population is younger and more racially diverse than SEER aggregate populations, and Kaiser Permanente members are insured with access to preventive care (eg, smoking cessation programs, cancer screening).
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Affiliation(s)
- Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Corrine E Munoz-Plaza
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Jennifer Gander
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Carmit McMullen
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Caryn Oshiro
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Douglas W Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jenny Staab
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Keong F, Gander J, Wilson D, Durthaler J, Pimentel B, Barzilay JI. Albuminuria Screening in People With Type 2 Diabetes in a Managed Care Organization. AJPM Focus 2023; 2:100133. [PMID: 37790952 PMCID: PMC10546502 DOI: 10.1016/j.focus.2023.100133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Albuminuria-an increased amount of urine albumin, in milligrams, adjusted for grams of urine creatinine-is an early marker of diabetic kidney disease. Several new classes of medications are now available that effectively lower albuminuria levels with the potential to delay or prevent the progression of diabetic kidney disease. However, screening for albuminuria in the U.S. is low in population-based studies (<10% to ∼50% at most). In this study, we examine whether screening for albuminuria was improved in an integrated model of healthcare delivery following the recommendations of the National Committee for Quality Assurance mandate (an umbrella group for the managed healthcare industry) to screen for albuminuria. Methods We examined screening for albuminuria over a 2-year period among people with Type 2 diabetes in a U.S. HMO with an electronic medical record, onto which automated laboratory ordering for albuminuria could be added when a patient appeared at the laboratory (for any reason) if albuminuria testing had not been obtained within the previous 365 days. Participants under this plan received diabetes education at no cost and panel managers to guide their diabetes care. Logistic regression using data from 2020 and 2021, separately, evaluated the relationship between patient characteristics and the likelihood of albuminuria screening. Results There were 20,688 and 22,487 participants with Type 2 diabetes mellitus in 2020 and 2021, respectively, who were analyzed. Approximately 80% were screened for albuminuria in both years. African American participants and those aged >64 years were more likely to have completed albuminuria screening. Screened individuals had lower HbA1c, blood pressure, and low-density lipoprotein cholesterol levels than those who were not screened. Conclusions In an integrated healthcare model, it is possible to achieve consistently high rates of albuminuria screening in people with Type 2 diabetes, especially in groups at high risk for kidney disease.
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Affiliation(s)
- Farrah Keong
- Business Intelligence Group, Kaiser Permanente of Georgia, Atlanta, Georgia
| | - Jennifer Gander
- Center for Research and Evaluation, Kaiser Permanente of Georgia, Atlanta, Georgia
| | - Daniel Wilson
- Division of Cardiorenal Medicine, U.S. Medical Affairs, Bayer Pharmaceuticals, LLC, Whippany, New Jersey
| | - Jeffrey Durthaler
- Division of Cardiorenal Medicine, U.S. Medical Affairs, Bayer Pharmaceuticals, LLC, Whippany, New Jersey
| | - Belkis Pimentel
- Department of Adult Medicine, Kaiser Permanente of Georgia, Atlanta, Georgia
- Department of Population Care Management, Kaiser Permanente of Georgia, Atlanta, Georgia
| | - Joshua I. Barzilay
- Division of Endocrinology, Kaiser Permanente of Georgia, Atlanta, Georgia
- Division of Endocrinology Metabolism and Lipids, Department of Medicine, Emory School of Medicine, Atlanta, Georgia
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Harding J, Patel S, Davis T, Patzer R, McDonald B, Walker-Williams D, Jagannathan R, Teunis L, Gander J. Study Protocol: A Mixed-Methods Study for Understanding Racial Disparities in COVID-19-Related Complications. JMIR Res Protoc 2022; 11:e38914. [PMID: 36166652 PMCID: PMC9555818 DOI: 10.2196/38914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/02/2022] [Accepted: 09/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background In the United States, the COVID-19 pandemic has magnified the disproportionate and long-standing health disparities experienced by Black communities. Although it is acknowledged that social determinants of health (SDOH) rather than biological factors likely contribute to this disparity, few studies using rigorous analytic approaches in large, information-rich community-based data sets are dedicated to understanding the underlying drivers of these racial disparities. Objective The overall aim of our study is to elucidate the mechanisms by which racial disparities in severe COVID-19 outcomes arise, using both quantitative and qualitative methods. Methods In this protocol, we outline a convergent parallel mixed methods approach to identifying, quantifying, and contextualizing factors that contribute to the dramatic disparity in COVID-19 severity (ie, hospitalization, mortality) in Black versus white COVID-19 patients within the integrated health care system of Kaiser Permanente Georgia (KPGA). Toward this end, we will generate two quantitative cohorts of KPGA members with a confirmed COVID-19 diagnosis between January 1, 2020, and September 30, 2021: (1) an electronic medical record (EMR) cohort including routinely captured data on diagnoses, medications, and laboratory values, and a subset of patients hospitalized at Emory Healthcare to capture additional in-hospital data; and (2) a survey cohort, where participants will answer a range of questions related to demographics (eg, race, education), usual health behaviors (eg, physical activity, smoking), impact of COVID-19 (eg, job loss, caregiving responsibilities), and medical mistrust. Key outcomes of interest for these two cohorts include hospitalization, mortality, intensive care unit admission, hospital readmission, and long COVID-19. Finally, we will conduct qualitative semistructured interviews to capture perceptions of and experiences of being hospitalized with COVID-19 as well as related interactions with KPGA health care providers. We will analyze and interpret the quantitative and qualitative data separately, and then integrate the qualitative and quantitative findings using a triangulation design approach. Results This study has been funded by a Woodruff Health Sciences grant from December 2020 to December 2022. As of August 31, 2022, 31,500 KPGA members diagnosed with COVID-19 have been included in the EMR cohort, including 3028 who were hospitalized at Emory Healthcare, and 482 KPGA members completed the survey. In addition, 20 KPGA members (10 Black and 10 white) have been interviewed about their experiences navigating care with COVID-19. Quantitative and qualitative data cleaning and coding have been completed. Data analysis is underway with results anticipated to be published in December 2022. Conclusions Results from this mixed methods pilot study in a diverse integrated care setting in the southeastern United States will provide insights into the mechanisms underpinning racial disparities in COVID-19 complications. The quantitative and qualitative data will provide important context to generate hypotheses around the mechanisms for racial disparities in COVID-19, and may help to inform the development of multilevel strategies to reduce the burden of racial disparities in COVID-19 and its ongoing sequelae. Incorporating contextual information, elucidated from qualitative interviews, will increase the efficacy, adoption, and sustainability of such strategies. International Registered Report Identifier (IRRID) RR1-10.2196/38914
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Affiliation(s)
- Jessica Harding
- Department of Surgery, Emory University, 101 Woodruff Circle Suite 1019, Atlanta, US
| | - Shivani Patel
- Hubert Department of Global Health, Emory University, Atlanta, US
| | | | - Rachel Patzer
- Department of Surgery, Emory University, 101 Woodruff Circle Suite 1019, Atlanta, US
| | | | | | | | - Larissa Teunis
- Department of Surgery, Emory University, 101 Woodruff Circle Suite 1019, Atlanta, US
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Gander J, Guandalino M, Vedrine N, Charbonnel C, Gayrel P, Ceruti F, Guy L. Comparaison des biopsies de prostate systématiques, ciblées et combinées pour le diagnostic de cancer de prostate en cas de lésion à l’IRM. Prog Urol 2022; 32:836-842. [DOI: 10.1016/j.purol.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/27/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
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Magua W, Basu M, Pastan SO, Kim JJ, Smith K, Gander J, Mohan S, Escoffery C, Plantinga LC, Melanson T, Garber MD, Patzer RE. Effect of the ASCENT Intervention to Increase Knowledge of Kidney Allocation Policy Changes Among Dialysis Providers. Kidney Int Rep 2020; 5:1422-1431. [PMID: 32954067 PMCID: PMC7486341 DOI: 10.1016/j.ekir.2020.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/29/2020] [Accepted: 06/23/2020] [Indexed: 11/26/2022] Open
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.
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Affiliation(s)
- Wairimu Magua
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mohua Basu
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephen O. Pastan
- Department of Medicine, Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joyce J. Kim
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kayla Smith
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer Gander
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Laura C. Plantinga
- Department of Medicine, Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Taylor Melanson
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael D. Garber
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rachel E. Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Medicine, Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia, USA
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Tan VS, Garg AX, McArthur E, Patzer RE, Gander J, Roshanov P, Kim SJ, Knoll GA, Yohanna S, McCallum MK, Naylor KL. Predicting 3-Year Survival in Patients Receiving Maintenance Dialysis: An External Validation of iChoose Kidney in Ontario, Canada. Can J Kidney Health Dis 2018; 5:2054358118799693. [PMID: 30302267 PMCID: PMC6172940 DOI: 10.1177/2054358118799693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/27/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Many patients with end-stage kidney disease (ESKD) do not appreciate how their survival may differ if treated with a kidney transplant compared with dialysis. A risk calculator (iChoose Kidney) developed and validated in the United States provides individualized mortality estimates for different treatment options (dialysis vs living or deceased donor kidney transplantation). The calculator can be used with patients and families to help patients make more educated treatment decisions. OBJECTIVE To validate the iChoose Kidney risk calculator in Ontario, Canada. DESIGN External validation study. SETTING We used several linked administrative health care databases from Ontario, Canada. PATIENTS We included 22 520 maintenance dialysis patients and 4505 kidney transplant recipients. Patients entered the cohort between 2004 and 2014. MEASUREMENTS Three-year all-cause mortality. METHODS We assessed model discrimination using the C-statistic. We assessed model calibration by comparing the observed versus predicted mortality risk and by using smoothed calibration plots. We used multivariable logistic regression modeling to recalibrate model intercepts using a correction factor, when appropriate. RESULTS In our final version of the iChoose Kidney model, we included the following variables: age (18-80 years), sex (male, female), race (white, black, other), time on dialysis (<6 months, 6-12 months, >12 months), and patient comorbidities (hypertension, diabetes, and/or cardiovascular disease). Over the 3-year follow-up period, 33.3% of dialysis patients and 6.2% of kidney transplant recipients died. The discriminatory ability was moderate (C-statistic for dialysis: 0.70, 95% confidence interval [CI]: 0.69-0.70, and C-statistic for transplant: 0.72, 95% CI: 0.69-0.75). The 3-year observed and predicted mortality estimates were comparable and even more so after we recalibrated the intercepts in 2 of our models (dialysis and deceased donor kidney transplantation). As done in the United States, we developed a Canadian Web site and an iOS application called Dialysis vs. Kidney Transplant- Estimated Survival in Ontario. LIMITATIONS Missing data in our databases precluded the inclusion of all variables that were in the original iChoose Kidney (ie, patient ethnicity and low albumin). We were unable to perform all preplanned analyses due to the limited sample size. CONCLUSIONS The original iChoose Kidney risk calculator was able to adequately predict mortality in this Canadian (Ontario) cohort of ESKD patients. After minor modifications, the predictive accuracy improved. The Dialysis vs. Kidney Transplant- Estimated Survival in Ontario risk calculator may be a valuable resource to help ESKD patients make an informed decision on pursuing kidney transplantation.
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Affiliation(s)
- Vivian S. Tan
- Division of Nephrology, Western University, London, ON, Canada
| | - Amit X. Garg
- Division of Nephrology, Western University, London, ON, Canada
- Institute for Clinical Evaluative Sciences, London, ON, Canada
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, London, ON, Canada
| | | | | | - Pavel Roshanov
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - S. Joseph Kim
- University Health Network, University of Toronto, ON, Canada
| | - Greg A. Knoll
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | | | | | - Kyla L. Naylor
- Institute for Clinical Evaluative Sciences, London, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada
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Wang CS, Gander J, Patzer RE, Greenbaum LA. Mortality and Allograft Loss Trends Among US Pediatric Kidney Transplant Recipients With and Without Focal Segmental Glomerulosclerosis. Am J Kidney Dis 2017; 71:392-398. [PMID: 29277509 DOI: 10.1053/j.ajkd.2017.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/30/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Pediatric patients with focal segmental glomerulosclerosis (FSGS) have high rates of disease recurrence and allograft failure after kidney transplantation, but there are few data for long-term survival posttransplantation. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 12,303 pediatric patients (aged <18 years), including 1,408 (11%) patients with FSGS, who received a first kidney transplant in 1990 through 2009 and were followed up through June 2015 were identified from the US Renal Data System database. PREDICTORS Primary cause of end-stage renal disease, FSGS or other. OUTCOMES All-cause patient mortality and allograft loss. RESULTS All-cause mortality significantly improved for patients with FSGS who underwent transplantation in the 2000s versus the 1990s (6.72 vs 12.24 deaths/1,000 patient-years; HR, 0.55; 95% CI, 0.39-0.78; P<0.001). Reductions in allograft loss were less dramatic (75.91 vs 89.05 events/1,000 patient-years; HR, 0.85; 95% CI, 0.74-0.98; P=0.02). After adjusting for baseline characteristics at the time of transplantation, patients with FSGS had similar rates of death compared with patients without FSGS (HRs of 0.81 [P=0.6] and 1.06 [P=0.2] among those who underwent transplantation in the 2000s and 1990s, respectively) despite higher rates of allograft loss (HRs of 1.17 [P=0.03] and 1.27 [P<0.001], respectively). Among patients who underwent transplantation in the 2000s, further adjustment for allograft failure as a time-varying covariate demonstrated a lower rate of death among patients with FSGS compared with those without FSGS (HR, 0.70; P=0.02). LIMITATIONS Lack of information about certain risk factors for mortality, including duration of chronic kidney disease; missing data; and potential primary disease misclassification. CONCLUSIONS Survival of pediatric kidney transplant recipients with FSGS improved between the 1990s and 2000s and was similar to that of recipients without FSGS. Interestingly, adjustment for allograft failure showed greater survival for pediatric patients with FSGS who underwent transplantation in the 2000s as compared with others, suggesting that effective interventions to decrease allograft loss due to disease recurrence may improve patient survival.
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Affiliation(s)
- Chia-Shi Wang
- Division of Pediatric Nephrology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA.
| | - Jennifer Gander
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Rachel E Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA; Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA
| | - Larry A Greenbaum
- Division of Pediatric Nephrology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
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Zhang X, Gander J, Plantinga LC, McPherson L, Basu M, Paul S, Pastan SO, Patzer RE. Kidney Transplantation Referral and Waitlisting Patterns among Dialysis Facilities in Georgia. Ann Epidemiol 2017. [DOI: 10.1016/j.annepidem.2017.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McPherson L, Basu M, Gander J, Pastan SO, Mohan S, Wolf MS, Chiles M, Russell A, Lipford K, Patzer RE. Decisional conflict between treatment options among end-stage renal disease patients evaluated for kidney transplantation. Clin Transplant 2017; 31. [PMID: 28457025 PMCID: PMC10067135 DOI: 10.1111/ctr.12991] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 11/26/2022]
Abstract
Although kidney transplantation provides a significant benefit over dialysis, many patients with end-stage renal disease (ESRD) are conflicted about their decision to undergo kidney transplant. We aimed to identify the prevalence and characteristics associated with decisional conflict between treatment options in ESRD patients presenting for transplant evaluation. Among a cross-sectional sample of patients with ESRD (n=464) surveyed in 2014 and 2015, we assessed decisional conflict through a validated 10-item questionnaire. Decisional conflict was dichotomized into no decisional conflict (score=0) and any decisional conflict (score>0). We investigated potential characteristics of patients with decisional conflict using bivariate and multivariable logistic regression. The overall mean age was 50.6 years, with 62% male patients and 48% African American patients. Nearly half (48.5%) of patients had decisional conflict regarding treatment options. Characteristics significantly associated with decisional conflict in multivariable analysis included male sex, lower educational attainment, and less transplant knowledge. Understanding characteristics associated with decisional conflict in patients with ESRD could help identify patients who may benefit from targeted interventions to help patients make informed, value-based, and supported decisions when deciding how to best treat their kidney disease.
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Affiliation(s)
- Laura McPherson
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohua Basu
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer Gander
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephen O Pastan
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sumit Mohan
- Renal and Pancreatic Transplant Program, Columbia University Medical Center, New York, NY, USA
| | - Michael S Wolf
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mariana Chiles
- Renal and Pancreatic Transplant Program, Columbia University Medical Center, New York, NY, USA
| | - Allison Russell
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristie Lipford
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Rachel E Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Patzer RE, Smith K, Basu M, Gander J, Mohan S, Escoffery C, Plantinga L, Melanson T, Kalloo S, Green G, Berlin A, Renville G, Browne T, Turgeon N, Caponi S, Zhang R, Pastan S. The ASCENT (Allocation System Changes for Equity in Kidney Transplantation) Study: a Randomized Effectiveness-Implementation Study to Improve Kidney Transplant Waitlisting and Reduce Racial Disparity. Kidney Int Rep 2017; 2:433-441. [PMID: 28845470 PMCID: PMC5568836 DOI: 10.1016/j.ekir.2017.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION The United Network for Organ Sharing (UNOS) implemented a new Kidney Allocation System (KAS) in December 2014 that is expected to substantially reduce racial disparities in kidney transplantation among waitlisted patients. However, not all dialysis facility clinical providers and end stage renal disease (ESRD) patients are aware of how the policy change could improve access to transplant. METHODS We describe the ASCENT (Allocation System Changes for Equity in KidNey Transplantation) study, a randomized controlled effectiveness-implementation study designed to test the effectiveness of a multicomponent intervention to improve access to the early steps of kidney transplantation among dialysis facilities across the United States. The multicomponent intervention consists of an educational webinar for dialysis medical directors, an educational video for patients and an educational video for dialysis staff, and a dialysis-facility specific transplant performance feedback report. Materials will be developed by a multidisciplinary dissemination advisory board and will undergo formative testing in dialysis facilities across the United States. RESULTS This study is estimated to enroll ~600 U.S. dialysis facilities with low waitlisting in all 18 ESRD Networks. The co-primary outcomes include change in waitlisting, and waitlist disparity at 1 year; secondary outcomes include changes in facility medical director knowledge about KAS, staff training regarding KAS, patient education regarding transplant, and a medical director's intent to refer patients for transplant evaluation. CONCLUSION The results from the ASCENT study will demonstrate the feasibility and effectiveness of a multicomponent intervention designed to increase access to the deceased-donor kidney waitlist and reduce racial disparities in waitlisting.
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Affiliation(s)
- Rachel E Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 101 Woodruff Circle, 5101 Woodruff Memorial Research Building, Atlanta, GA 30322.,Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine 1518 Clifton Road Atlanta, GA 30322.,Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University School of Medicine, 1518 Clifton Road, Atlanta, GA 30322
| | - Kayla Smith
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 101 Woodruff Circle, 5101 Woodruff Memorial Research Building, Atlanta, GA 30322
| | - Mohua Basu
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 101 Woodruff Circle, 5101 Woodruff Memorial Research Building, Atlanta, GA 30322
| | - Jennifer Gander
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 101 Woodruff Circle, 5101 Woodruff Memorial Research Building, Atlanta, GA 30322
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, College of Physicians & Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, 622 West 169th Street, New York, NY 10032
| | - Cam Escoffery
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine 1518 Clifton Road Atlanta, GA 30322
| | - Laura Plantinga
- Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, 101 Woodruff Circle, 5101 Woodruff Memorial Research Building, Atlanta, GA 30322
| | - Taylor Melanson
- Department of Health Policy Management, Rollins School of Public Health, Emory School of Medicine, 1518 Clifton Road, Atlanta, GA 30322
| | - Sean Kalloo
- Department of Medicine, Division of Nephrology, College of Physicians & Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, 622 West 169th Street, New York, NY 10032
| | - Gary Green
- American Association of Kidney Patients, 2701 N. Rocky Point Drive, Suite 150, Tampa, FL 33607
| | - Alex Berlin
- Southeastern Kidney Transplant Coalition, Atlanta, GA 30322
| | - Gary Renville
- National Kidney Foundation, 270 Peachtree St NE #1040, Atlanta, GA 30303
| | - Teri Browne
- University of South Carolina, College of Social Work, 902 Sumter Street, Columbia, SC 29208
| | - Nicole Turgeon
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 101 Woodruff Circle, 5101 Woodruff Memorial Research Building, Atlanta, GA 30322
| | - Susan Caponi
- US ESRD Network 2, 1979 Marcus Ave, Lake Success, NY 11042
| | - Rebecca Zhang
- Department of Biostatistics, Rollins School of Public Health, Emory University School of Medicine, 1518 Clifton Road, Atlanta, GA 30322
| | - Stephen Pastan
- Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, 101 Woodruff Circle, 5101 Woodruff Memorial Research Building, Atlanta, GA 30322
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Patzer RE, Paul S, Plantinga L, Gander J, Sauls L, Krisher J, Mulloy LL, Gibney EM, Browne T, Zayas CF, McClellan WM, Arriola KJ, Pastan SO. A Randomized Trial to Reduce Disparities in Referral for Transplant Evaluation. J Am Soc Nephrol 2016; 28:935-942. [PMID: 27738125 DOI: 10.1681/asn.2016030320] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/01/2016] [Indexed: 11/03/2022] Open
Abstract
Georgia has the lowest kidney transplant rates in the United States and substantial racial disparities in transplantation. We determined the effectiveness of a multicomponent intervention to increase referral of patients on dialysis for transplant evaluation in the Reducing Disparities in Access to kidNey Transplantation Community Study (RaDIANT), a randomized, dialysis facility-based, controlled trial involving >9000 patients receiving dialysis from 134 dialysis facilities in Georgia. In December of 2013, we selected dialysis facilities with either low transplant referral or racial disparity in referral. The intervention consisted of transplant education and engagement activities targeting dialysis facility leadership, staff, and patients conducted from January to December of 2014. We examined the proportion of patients with prevalent ESRD in each facility referred for transplant within 1 year as the primary outcome, and disparity in the referral of black and white patients as a secondary outcome. Compared with control facilities, intervention facilities referred a higher proportion of patients for transplant at 12 months (adjusted mean difference [aMD], 7.3%; 95% confidence interval [95% CI], 5.5% to 9.2%; odds ratio, 1.75; 95% CI, 1.36 to 2.26). The difference between intervention and control facilities in the proportion of patients referred for transplant was higher among black patients (aMD, 6.4%; 95% CI, 4.3% to 8.6%) than white patients (aMD, 3.7%; 95% CI, 1.6% to 5.9%; P<0.05). In conclusion, this intervention increased referral and improved equity in kidney transplant referral for patients on dialysis in Georgia; long-term follow-up is needed to determine whether these effects led to more transplants.
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Affiliation(s)
- Rachel E Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia; .,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Laura Plantinga
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer Gander
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, Georgia
| | - Leighann Sauls
- Southeastern Kidney Council, Inc., End Stage Renal Disease Network 6, Raleigh, North Carolina
| | - Jenna Krisher
- Southeastern Kidney Council, Inc., End Stage Renal Disease Network 6, Raleigh, North Carolina
| | - Laura L Mulloy
- Division of Nephrology, Hypertension, and Transplant, Augusta University, Augusta, Georgia
| | | | - Teri Browne
- University of South Carolina College of Social Work, Columbia, South Carolina; and
| | - Carlos F Zayas
- Division of Nephrology, Hypertension, and Transplant, Augusta University, Augusta, Georgia
| | - William M McClellan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kimberly Jacob Arriola
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, Georgia
| | - Stephen O Pastan
- Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia
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Patzer RE, Basu M, Mohan S, Smith KD, Wolf M, Ladner D, Friedewald JJ, Chiles M, Russell A, McPherson L, Gander J, Pastan S. A Randomized Controlled Trial of a Mobile Clinical Decision Aid to Improve Access to Kidney Transplantation: iChoose Kidney. Kidney Int Rep 2016; 1:34-42. [PMID: 27610423 PMCID: PMC5012277 DOI: 10.1016/j.ekir.2016.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Kidney transplantation is the preferred treatment for patients with end-stage renal disease, as it substantially increases a patient’s survival and is cost-saving compared to a lifetime of dialysis. However, transplantation is not universally chosen by patients with renal failure, and limited knowledge about the survival benefit of transplantation versus dialysis may play a role. We created a mobile application clinical decision aid called iChoose Kidney to improve access to individualized prognosis information comparing dialysis and transplantation outcomes. Methods We describe the iChoose Kidney study, a randomized controlled trial designed to test the clinical efficacy of a mobile health decision aid among end-stage renal disease patients referred for kidney transplantation at 3 large, diverse transplant centers across the United States. Approximately 450 patients will be randomized to receive either (i) standard of care or “usual” transplantation education, or (ii) standard of care plus iChoose Kidney. Results The primary outcome is change in knowledge about the survival benefit of kidney transplantation versus dialysis from baseline to immediate follow-up; secondary outcomes include change in treatment preferences, improved decisional conflict, and increased access to kidney transplantation. Analyses are also planned to examine effectiveness across subgroups of race, socioeconomic status, health literacy, and health numeracy. Discussion Engaging patients in health care choices can increase patient empowerment and improve knowledge and understanding of treatment choices. If the effectiveness of iChoose Kidney has a greater impact on patients with low health literacy, lower socioeconomic status, and minority race, this decision aid could help reduce disparities in access to kidney transplantation.
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Affiliation(s)
- Rachel E Patzer
- Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322
| | - Mohua Basu
- Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322
| | - Sumit Mohan
- Renal and Pancreatic Transplant Program: Columbia University Medical Center, 622 West 169th Street, New York, NY 10032
| | - Kayla D Smith
- Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322
| | - Michael Wolf
- Northwestern University Comprehensive Transplant Center, 676 St. Clair Street #1900, Chicago, IL 60611
| | - Daniela Ladner
- Northwestern University Comprehensive Transplant Center, 676 St. Clair Street #1900, Chicago, IL 60611
| | - John J Friedewald
- Northwestern University Comprehensive Transplant Center, 676 St. Clair Street #1900, Chicago, IL 60611
| | - Mariana Chiles
- Renal and Pancreatic Transplant Program: Columbia University Medical Center, 622 West 169th Street, New York, NY 10032
| | - Allison Russell
- Northwestern University Comprehensive Transplant Center, 676 St. Clair Street #1900, Chicago, IL 60611
| | - Laura McPherson
- Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322
| | - Jennifer Gander
- Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322
| | - Stephen Pastan
- Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322
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Browne T, Amamoo A, Patzer RE, Krisher J, Well H, Gander J, Pastan SO. Everybody needs a cheerleader to get a kidney transplant: a qualitative study of the patient barriers and facilitators to kidney transplantation in the Southeastern United States. BMC Nephrol 2016; 17:108. [PMID: 27476111 PMCID: PMC4967312 DOI: 10.1186/s12882-016-0326-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/27/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Kidney transplantation (KTx) disparity is a significant problem in the United States, particularly in the Southeastern region. In response to this phenomenon, the Southeastern Kidney Transplant Coalition was created in 2011 to increase the KTx rate, and to reduce disparities in access to transplantation in the Southeast, by identifying and reducing barriers in the transplant process. METHODS To determine perceived barriers and facilitators to KTx that dialysis patients in this region experience, we conducted three focus groups with 40 total patients in Georgia, North Carolina, and South Carolina. RESULTS We identified two novel themes specific to Southeastern dialysis patients that describe the major barriers and facilitators to kidney transplantation: dialysis center approaches to patient education about KTx, and dialysis center advocacy and encouragement for KTx. In addition, themes related to barriers and facilitators of KTx were evident that were previously mentioned in the literature such as age, fear, knowing other patients with good or bad experiences with KTx, distrust of the KTx process equity, financial concerns and medical barriers. CONCLUSIONS Dialysis providers are encouraged to enhance their delivery of information and active assistance to underserved patients related to KTx.
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Affiliation(s)
- Teri Browne
- College of Social Work, University of South Carolina, 12 Hamilton, Columbia, SC, 29208, USA.
| | - Ahinee Amamoo
- Southeastern Kidney Council, 1000 St. Albans Drive, Suite 270, Raleigh, NC, 27609, USA
| | - Rachel E Patzer
- School of Medicine, Emory University, 101 Woodruff Circle, 5105 WMB, Atlanta, GA, 30322, USA
| | - Jenna Krisher
- Southeastern Kidney Council, 1000 St. Albans Drive, Suite 270, Raleigh, NC, 27609, USA
| | - Henry Well
- National Kidney Foundation, 508 Hampton Street, Columbia, SC, 29201, USA
| | - Jennifer Gander
- School of Medicine, Emory University, 101 Woodruff Circle, 5105 WMB, Atlanta, GA, 30322, USA
| | - Stephen O Pastan
- School of Medicine, Emory University, 101 Woodruff Circle, 5105 WMB, Atlanta, GA, 30322, USA
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Browne T, Patzer RE, Gander J, Amamoo MA, Krisher J, Sauls L, Pastan S. Kidney transplant referral practices in southeastern dialysis units. Clin Transplant 2016; 30:365-71. [PMID: 26782140 DOI: 10.1111/ctr.12693] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND The Southeastern Kidney Transplant Coalition was created in 2010 to improve kidney transplant (KTx) rates in Georgia, North Carolina, and South Carolina. To identify dialysis staff-reported barriers to transplant, the Coalition developed a survey of dialysis providers in the region. METHODS All dialysis units in the ESRD Network (n = 586) were sent a survey to be completed by the professional responsible for helping patients get transplants. RESULTS One staff member at almost all (n = 546) of the dialysis units in Network 6 completed the survey (93% response rate). Almost all respondents reported being very comfortable (51.47%) or comfortable (46.89%) discussing the KTx process with patients. Just over half (56%) of facilities reported discussing KTx as a treatment option with patients on an annual basis. Fewer than one quarter of respondents (19%) perceived that more than 50% of their patients were interested in kidney transplant, and most of the staff surveyed (68%) reported that <25% of their dialysis patients completed the evaluation process and been wait-listed for a kidney transplant. CONCLUSION The survey results provide insight into KTx referral practices in southeastern dialysis units that may be contributing to low KTx rates in this region.
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Affiliation(s)
- Teri Browne
- University of South Carolina, Columbia, SC, USA
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Patzer RE, Plantinga LC, Paul S, Gander J, Krisher J, Sauls L, Gibney EM, Mulloy L, Pastan SO. Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia. JAMA 2015; 314:582-94. [PMID: 26262796 PMCID: PMC4571496 DOI: 10.1001/jama.2015.8897] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Dialysis facilities in the United States are required to educate patients with end-stage renal disease about all treatment options, including kidney transplantation. Patients receiving dialysis typically require a referral for kidney transplant evaluation at a transplant center from a dialysis facility to start the transplantation process, but the proportion of patients referred for transplantation is unknown. OBJECTIVE To describe variation in dialysis facility-level referral for kidney transplant evaluation and factors associated with referral among patients initiating dialysis in Georgia, the US state with the lowest kidney transplantation rates. DESIGN, SETTING, AND PARTICIPANTS Examination of United States Renal Data System data from a cohort of 15,279 incident, adult (18-69 years) patients with end-stage renal disease from 308 Georgia dialysis facilities from January 2005 to September 2011, followed up through September 2012, linked to kidney transplant referral data collected from adult transplant centers in Georgia in the same period. MAIN OUTCOMES AND MEASURES Referral for kidney transplant evaluation within 1 year of starting dialysis at any of the 3 Georgia transplant centers was the primary outcome; placement on the deceased donor waiting list was also examined. RESULTS The median within-facility percentage of patients referred within 1 year of starting dialysis was 24.4% (interquartile range, 16.7%-33.3%) and varied from 0% to 75.0%. Facilities in the lowest tertile of referral (<19.2%) were more likely to treat patients living in high-poverty neighborhoods (absolute difference, 21.8% [95% CI, 14.1%-29.4%]), had a higher patient to social worker ratio (difference, 22.5 [95% CI, 9.7-35.2]), and were more likely nonprofit (difference, 17.6% [95% CI, 7.7%-27.4%]) compared with facilities in the highest tertile of referral (>31.3%). In multivariable, multilevel analyses, factors associated with lower referral for transplantation, such as older age, white race, and nonprofit facility status, were not always consistent with the factors associated with lower waitlisting. CONCLUSIONS AND RELEVANCE In Georgia overall, a limited proportion of patients treated with dialysis were referred for kidney transplant evaluation between 2005 and 2011, but there was substantial variability in referral among facilities. Variables associated with referral were not always associated with waitlisting, suggesting that different factors may account for disparities in referral.
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Affiliation(s)
- Rachel E Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia2Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia3Emory Transplant Center, Atlanta, Georgia
| | - Laura C Plantinga
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia4Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Jennifer Gander
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jenna Krisher
- Southeastern Kidney Council Inc of End Stage Renal Disease Network 6, Raleigh, North Carolina
| | - Leighann Sauls
- Southeastern Kidney Council Inc of End Stage Renal Disease Network 6, Raleigh, North Carolina
| | - Eric M Gibney
- Piedmont Transplant Institute, Piedmont Healthcare, Atlanta, Georgia
| | - Laura Mulloy
- Division of Nephrology, Department of Medicine, Georgia Regents University, Augusta
| | - Stephen O Pastan
- Emory Transplant Center, Atlanta, Georgia4Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Gander J, Browne T, Plantinga L, Pastan SO, Sauls L, Krisher J, Patzer RE. Dialysis Facility Transplant Philosophy and Access to Kidney Transplantation in the Southeast. Am J Nephrol 2015; 41:504-11. [PMID: 26278585 DOI: 10.1159/000438463] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/06/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about the impact of dialysis facility treatment philosophy on access to transplant. The aim of our study was to determine the relationship between the dialysis facility transplant philosophy and facility-level access to kidney transplant waitlisting. METHODS A 25-item questionnaire administered to Southeastern dialysis facilities (n = 509) in 2012 captured the facility transplant philosophy (categorized as 'transplant is our first choice', 'transplant is a great option for some', and 'transplant is a good option, if the patient is interested'). Facility-level waitlisting and facility characteristics were obtained from the 2008-2011 Dialysis Facility Report. Multivariable logistic regression was used to examine the association between the dialysis facility transplant philosophy and facility waitlisting performance (dichotomized using the national median), where low performance was defined as fewer than 21.7% of dialysis patients waitlisted within a facility. RESULTS Fewer than 25% (n = 124) of dialysis facilities reported 'transplant is our first option'. A total of 131 (31.4%) dialysis facilities in the Southeast were high-performing facilities with respect to waitlisting. Adjusted analysis showed that facilities who reported 'transplant is our first option' were twice (OR 2.0; 95% CI 1.0-3.9) as likely to have high waitlisting performance compared to facilities who reported that 'transplant is a good option, if the patient is interested'. CONCLUSIONS Facilities with staff who had a more positive transplant philosophy were more likely to have better facility waitlisting performance. Future prospective studies are needed to further investigate if improving the kidney transplant philosophy in dialysis facilities improves access to transplantation.
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Gander J. Addition of Estimated Cardiorespiratory Fitness to the Clinical Assessment of 10-Year Coronary Heart Disease Risk in Asymptomatic Men. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000477283.83118.6e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brahmbhatt R, Gander J, Perez S, Brewster L, Duwayri Y, Rajani R, Shafii S, Veeraswamy R, Salam A, Arya S. Improved Trends in Patient Survival and Decreased Major Complications After Emergency Ruptured Abdominal Aortic Aneurysm Repair From 2005 to 2011. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.09.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Patzer RE, Gander J, Sauls L, Amamoo MA, Krisher J, Mulloy LL, Gibney E, Browne T, Plantinga L, Pastan SO. The RaDIANT community study protocol: community-based participatory research for reducing disparities in access to kidney transplantation. BMC Nephrol 2014; 15:171. [PMID: 25348614 PMCID: PMC4230631 DOI: 10.1186/1471-2369-15-171] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/23/2014] [Indexed: 11/13/2022] Open
Abstract
Background The Southeastern United States has the lowest kidney transplant rates in the nation, and racial disparities in kidney transplant access are concentrated in this region. The Southeastern Kidney Transplant Coalition (SEKTC) of Georgia, North Carolina, and South Carolina is an academic and community partnership that was formed with the mission to improve access to kidney transplantation and reduce disparities among African American (AA) end stage renal disease (ESRD) patients in the Southeastern United States. Methods/Design We describe the community-based participatory research (CBPR) process utilized in planning the Reducing Disparities In Access to kidNey Transplantation (RaDIANT) Community Study, a trial developed by the SEKTC to reduce health disparities in access to kidney transplantation among AA ESRD patients in Georgia, the state with the lowest kidney transplant rates in the nation. The SEKTC Coalition conducted a needs assessment of the ESRD population in the Southeast and used results to develop a multicomponent, dialysis facility-randomized, quality improvement intervention to improve transplant access among dialysis facilities in GA. A total of 134 dialysis facilities are randomized to receive either: (1) standard of care or “usual” transplant education, or (2) the multicomponent intervention consisting of transplant education and engagement activities targeting dialysis facility leadership, staff, and patients within dialysis facilities. The primary outcome is change in facility-level referral for kidney transplantation from baseline to 12 months; the secondary outcome is reduction in racial disparity in transplant referral. Discussion The RaDIANT Community Study aims to improve equity in access to kidney transplantation for ESRD patients in the Southeast. Trial registration Clinicaltrials.gov number NCT02092727.
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Affiliation(s)
- Rachel E Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA, USA.
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Gander J, Sui X, Hazlett LJ, Cai B, Hébert JR, Blair SN. Factors related to coronary heart disease risk among men: validation of the Framingham Risk Score. Prev Chronic Dis 2014; 11:E140. [PMID: 25121352 PMCID: PMC4133511 DOI: 10.5888/pcd11.140045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction Coronary heart disease (CHD) remains a leading cause of death in the United States. The Framingham Risk Score (FRS) was developed to help clinicians in determining their patients’ CHD risk. We hypothesize that the FRS will be significantly predictive of CHD events among men in the Aerobics Center Longitudinal Study (ACLS) population. Methods Our study consisted of 34,557 men who attended the Cooper Clinic in Dallas, Texas, for a baseline clinical examination from 1972 through 2002. CHD events included self-reported myocardial infarction or revascularization or death due to CHD. During the 12-year follow-up 587 CHD events occurred. Multivariable-adjusted hazard ratios generated from ACLS analysis were compared with the application of FRS to the Framingham Heart Study (FHS). Results The ACLS cohort produced similar hazard ratios to the FHS. The adjusted Cox proportional hazard model revealed that men with total cholesterol of 280 mg/dL or greater were 2.21 (95% confidence interval (CI), 1.59–3.09) times more likely to have a CHD event than men with total cholesterol from 160 through 199mg/dL; men with diabetes were 1.63 (95% CI, 1.35–1.98) times more likely to experience a CHD event than men without diabetes. Conclusion The FRS significantly predicts CHD events in the ACLS cohort. To the best of our knowledge, this is the first report of a large, single-center cohort study to validate the FRS by using extensive laboratory and clinical measurements.
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Affiliation(s)
| | - Xuemei Sui
- University of South Carolina, 921 Assembly Street, Rm 226, Columbia, SC 29208. E-mail:
| | | | - Bo Cai
- University of South Carolina, Columbia, South Carolina
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Gander J, Lee DC, Sui X, Hébert JR, Hooker SP, Blair SN. Self-rated health status and cardiorespiratory fitness as predictors of mortality in men. Br J Sports Med 2011; 45:1095-100. [PMID: 21659563 DOI: 10.1136/bjsm.2010.079855] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Self-rated health (SRH) and cardiorespiratory fitness (fitness) are independent risk factors for all-cause mortality. The purpose of this report is to examine the single and joint effects of these exposures on mortality risk. The study included 18 488 men who completed a health survey, clinical examination and a maximal exercise treadmill test during 1987-2003. Cox regression analysis was used to quantify the associations of SRH and fitness with all-cause mortality. There were 262 deaths during 17 years of follow-up. There was a significant inverse trend (p(trend) <0.05) for mortality across SRH categories after adjustment for age, examination year, body mass index, physical activity, smoking, alcohol consumption, abnormal ECG, hypertension, hypercholesterolaemia, cardiovascular disease, diabetes and cancer. Adjustment for fitness attenuated the association (p value =0.09). The authors also observed an inverse association between fitness and mortality after controlling for the same covariates and SRH (p(trend) = 0.006). The combined analysis of SRH and fitness showed that fit men with good or excellent SRH had a 58% lower risk of mortality than their counterparts. SRH and fitness were both associated with all-cause mortality in men. Fit men with good or excellent SRH live longer than unfit men with poor or fair SRH.
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Affiliation(s)
- Jennifer Gander
- University of South Carolina, Columbia, South Carolina 29208, USA.
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Abstract
Oat spelts xylan (OSX), fucoidan, kappa carrageenan and chondroitin sulfates A and C were sulfated using chlorosulfonic acid-pyridine complex while the first three were phosphorylated using methane sulfonic acid-phosphorous pentoxide mixture. The compounds were isolated as the sodium salts and their in vitro anticoagulant properties were determined by measuring the concentration of each compound required to double prothrombin time of pooled normal human plasma. The results of 31P-nmr spectroscopy showed that phosphorylation significantly increased the molecular weights of the polysaccharides by forming phosphodiester and diphosphodiester bonds. In general the anticoagulant properties of the sulfated polysaccharides were related to the % sulfate while the phosphorylated polysaccharides showed increases in anticoagulant properties which were related to the increase in the molecular weight and inversely related to the % phosphate. The mechanism of action of oat spelts xylan phosphate (OSXP) was studied using 125I-thrombin and normal human plasma. The results showed that at lower concentration of the OSXP, the complexation of 125I-thrombin with heparin cofactor-II(HC-II) was enhanced, while at higher concentration of the compound, the complexation with both antithrombin-III(AT-III) and HC-II was enhanced.
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Affiliation(s)
- R Dace
- Chemistry Department, Prairie View A&M University, TX 77446, USA
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