1
|
Caldwell HA, Yusuf J, Carrea C, Conrad P, Embrett M, Fierlbeck K, Hajizadeh M, Kirk SF, Rothfus M, Sampalli T, Sim SM, Tomblin Murphy G, Williams L. Strategies and indicators to integrate health equity in health service and delivery systems in high-income countries: a scoping review. JBI Evid Synth 2024; 22:949-1070. [PMID: 38632975 PMCID: PMC11163892 DOI: 10.11124/jbies-23-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE The objective of this review was to describe how health service and delivery systems in high-income countries define and operationalize health equity. A secondary objective was to identify implementation strategies and indicators being used to integrate and measure health equity. INTRODUCTION To improve the health of populations, a population health and health equity approach is needed. To date, most work on health equity integration has focused on reducing health inequities within public health, health care delivery, or providers within a health system, but less is known about integration across the health service and delivery system. INCLUSION CRITERIA This review included academic and gray literature sources that described the definitions, frameworks, level of integration, strategies, and indicators that health service and delivery systems in high-income countries have used to describe, integrate, and/or measure health equity. Sources were excluded if they were not available in English (or a translation was not available), were published before 1986, focused on strategies that were not implemented, did not provide health equity indicators, or featured strategies that were implemented outside the health service or delivery systems (eg, community-based strategies). METHODS This review was conducted in accordance with the JBI methodology for scoping reviews. Titles and abstracts were screened for eligibility followed by a full-text review to determine inclusion. The information extracted from the included studies consisted of study design and key findings, such as health equity definitions, strategies, frameworks, level of integration, and indicators. Most data were quantitatively tabulated and presented according to 5 secondary review questions. Some findings (eg, definitions and indicators) were summarized using qualitative methods. Most findings were visually presented in charts and diagrams or presented in tabular format. RESULTS Following review of 16,297 titles and abstracts and 824 full-text sources, we included 122 sources (108 scholarly and 14 gray literature) in this scoping review. We found that health equity was inconsistently defined and operationalized. Only 17 sources included definitions of health equity, and we found that both indicators and strategies lacked adequate descriptions. The use of health equity frameworks was limited and, where present, there was little consistency or agreement in their use. We found that strategies were often specific to programs, services, or clinics, rather than broadly applied across health service and delivery systems. CONCLUSIONS Our findings suggest that strategies to advance health equity work are siloed within health service and delivery systems, and are not currently being implemented system-wide (ie, across all health settings). Healthy equity definitions and frameworks are varied in the included sources, and indicators for health equity are variable and inconsistently measured. Health equity integration needs to be prioritized within and across health service and delivery systems. There is also a need for system-wide strategies to promote health equity, alongside robust accountability mechanisms for measuring health equity. This is necessary to ensure that an integrated, whole-system approach can be consistently applied in health service and delivery systems internationally. REVIEW REGISTRATION DalSpace dalspace.library.dal.ca/handle/10222/80835.
Collapse
Affiliation(s)
- Hilary A.T. Caldwell
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Joshua Yusuf
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Cecilia Carrea
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Patricia Conrad
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Katherine Fierlbeck
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- MacEachen Institute for Public Policy and Governance, Dalhousie University, Halifax, NS, Canada
- Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Mohammad Hajizadeh
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sara F.L. Kirk
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Melissa Rothfus
- Department of Political Science, Dalhousie University, Halifax, NS, Canada
| | | | - Sarah Meaghan Sim
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | | | - Lane Williams
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
2
|
Waterman AD, Davis LA, Al Awadhi S. Unraveling Barriers in Access to Living Donor Kidney Transplantation for South Asian Canadian Populations. Am J Kidney Dis 2024; 83:710-712. [PMID: 38613542 DOI: 10.1053/j.ajkd.2024.01.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Amy D Waterman
- Department of Surgery, Houston Methodist Hospital, Houston, Texas.
| | - LaShara A Davis
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Solaf Al Awadhi
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| |
Collapse
|
3
|
Gordon EJ, Lee J, Kang R, Uriarte J, Caicedo JC. Disparities Persist Among Hispanic Patients: Completing Evaluation, Waitlisting, and Receiving a Kidney Transplant. Transplant Direct 2024; 10:e1595. [PMID: 38414978 PMCID: PMC10898667 DOI: 10.1097/txd.0000000000001595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/10/2024] [Indexed: 02/29/2024] Open
Abstract
Background Hispanic patients receive disproportionately fewer kidney transplants (KT) than non-Hispanic White (NHW) patients. In this observational study, we evaluated disparities in completing evaluation steps to KT among Hispanic patients. Methods Using medical records of Hispanic and NHW patients initiating evaluation at 4 transplant centers from January 2011 to March 2020, we performed sequential Cox models to compare Hispanic versus NHW patients reaching each step of the evaluation process until receiving a KT. Results Among all 5197 patients (Hispanic n = 2473; NHW n = 2724) initiating evaluation, Hispanic patients had 8% lower risk to be approved by the kidney pancreas (KP) committee than NHW patients (adjusted hazard ratio [aHR], 0.92; 95% confidence intervals (CI), 0.86-0.98; P = 0.015). Among 3492 patients approved by the KP committee, Hispanic patients had 13% lower risk to be waitlisted than NHW patients (aHR, 0.87; 95% CI, 0.81-0.94; P = 0.004). Among 3382 patients who were waitlisted, Hispanic patients had 11% lower risk than NHW patients to receive KT (aHR, 0.89; 95% CI, 0.81-0.97; P = 0.011). Among all patients initiating evaluation, Hispanic patients had a 16% lower risk than NHW patients to reach KT (aHR, 0.84; 95% CI, 0.76-0.92; P = 0.0002). Conclusions Our study found that disproportionately fewer Hispanic patients were approved by the KP committee, were waitlisted, and received a KT, particularly a living donor kidney transplant, than NHW patients. Closer oversight of the evaluation process may help patients overcome challenges in access to KT.
Collapse
Affiliation(s)
- Elisa J. Gordon
- Department of Surgery, and Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN
| | - Jungwha Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Raymond Kang
- Center for Community Health, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jefferson Uriarte
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Juan Carlos Caicedo
- Department of Surgery, Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
4
|
McElroy LM, Mohottige D, Cooper A, Sanoff S, Davis LA, Collins BH, Gordon EJ, Wang V, Boulware LE. Improving Health Equity in Living Donor Kidney Transplant: Application of an Implementation Science Framework. Transplant Proc 2024; 56:68-74. [PMID: 38184377 DOI: 10.1016/j.transproceed.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Interventions to improve racial equity in access to living donor kidney transplants (LDKT) have focused primarily on patients, ignoring the contributions of clinicians, transplant centers, and health system factors. Obtaining access to LDKT is a complex, multi-step process involving patients, their families, clinicians, and health system functions. An implementation science framework can help elucidate multi-level barriers to achieving racial equity in LDKT and guide the implementation of interventions targeted at all levels. METHODS We adopted the Pragmatic Robust Implementation and Sustainability Model (PRISM), an implementation science framework for racial equity in LDKT. The purpose was to provide a guide for assessment, inform intervention design, and support planning for the implementation of interventions. RESULTS We applied 4 main PRISM domains to racial equity in LDKT: Organizational Characteristics, Program Components, External Environment, and Patient Characteristics. We specified elements within each domain that consider perspectives of the health system, transplant center, clinical staff, and patients. CONCLUSION The applied PRISM framework provides a foundation for the examination of multi-level influences across the entirety of LDKT care. Researchers, quality improvement staff, and clinicians can use the applied PRISM framework to guide the assessment of inequities, support collaborative intervention development, monitor intervention implementation, and inform resource allocation to improve equity in access to LDKT.
Collapse
Affiliation(s)
- Lisa M McElroy
- Department of Surgery, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina.
| | | | - Alexandra Cooper
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Scott Sanoff
- Department of Medicine, Duke University, Durham, North Carolina
| | - LaShara A Davis
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas
| | | | - Elisa J Gordon
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Virginia Wang
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - L Ebony Boulware
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| |
Collapse
|
5
|
Rizzolo K, Shen JI. Barriers to home dialysis and kidney transplantation for socially disadvantaged individuals. Curr Opin Nephrol Hypertens 2024; 33:26-33. [PMID: 38014998 DOI: 10.1097/mnh.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW People with kidney disease facing social disadvantage have multiple barriers to quality kidney care. The aim of this review is to summarize the patient, clinician, and system wide factors that impact access to quality kidney care and discuss potential solutions to improve outcomes for socially disadvantaged people with kidney disease. RECENT FINDINGS Patient level factors such as poverty, insurance, and employment affect access to care, and low health literacy and kidney disease awareness can affect engagement with care. Clinician level factors include lack of early nephrology referral, limited education of clinicians in home dialysis and transplantation, and poor patient-physician communication. System-level factors such as lack of predialysis care and adequate health insurance can affect timely access to care. Neighborhood level socioeconomic factors, and lack of inclusion of these factors into public policy payment models, can affect ability to access care. Moreover, the effects of structural racism and discrimination nay negatively affect the kidney care experience for racially and ethnically minoritized individuals. SUMMARY Patient, clinician, and system level factors affect access to and engagement in quality kidney care. Multilevel solutions are critical to achieving equitable care for all affected by kidney disease.
Collapse
Affiliation(s)
- Katherine Rizzolo
- Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Section of Nephrology
| | - Jenny I Shen
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| |
Collapse
|
6
|
Gustafson P, Abdul Aziz Y, Lambert M, Bartholomew K, Rankin N, Fusheini A, Brown R, Carswell P, Ratima M, Priest P, Crengle S. A scoping review of equity-focused implementation theories, models and frameworks in healthcare and their application in addressing ethnicity-related health inequities. Implement Sci 2023; 18:51. [PMID: 37845686 PMCID: PMC10578009 DOI: 10.1186/s13012-023-01304-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Inequities in implementation contribute to the unequal benefit of health interventions between groups of people with differing levels of advantage in society. Implementation science theories, models and frameworks (TMFs) provide a theoretical basis for understanding the multi-level factors that influence implementation outcomes and are used to guide implementation processes. This study aimed to identify and analyse TMFs that have an equity focus or have been used to implement interventions in populations who experience ethnicity or 'race'-related health inequities. METHODS A scoping review was conducted to identify the relevant literature published from January 2011 to April 2022 by searching electronic databases (MEDLINE and CINAHL), the Dissemination and Implementation model database, hand-searching key journals and searching the reference lists and citations of studies that met the inclusion criteria. Titles, abstracts and full-text articles were screened independently by at least two researchers. Data were extracted from studies meeting the inclusion criteria, including the study characteristics, TMF description and operationalisation. TMFs were categorised as determinant frameworks, classic theories, implementation theories, process models and evaluation frameworks according to their overarching aim and described with respect to how equity and system-level factors influencing implementation were incorporated. RESULTS Database searches yielded 610 results, 70 of which were eligible for full-text review, and 18 met the inclusion criteria. A further eight publications were identified from additional sources. In total, 26 papers describing 15 TMFs and their operationalisation were included. Categorisation resulted in four determinant frameworks, one implementation theory, six process models and three evaluation frameworks. One framework included elements of determinant, process and evaluation TMFs and was therefore classified as a 'hybrid' framework. TMFs varied in their equity and systems focus. Twelve TMFs had an equity focus and three were established TMFs applied in an equity context. All TMFs at least partially considered systems-level factors, with five fully considering macro-, meso- and micro-level influences on equity and implementation. CONCLUSIONS This scoping review identifies and summarises the implementation science TMFs available to support equity-focused implementation. This review may be used as a resource to guide TMF selection and illustrate how TMFs have been utilised in equity-focused implementation activities.
Collapse
Affiliation(s)
- Papillon Gustafson
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand
| | - Yasmin Abdul Aziz
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand
| | - Karen Bartholomew
- Te Whatu Ora Waitematā and Te Toka Tumai Auckland, Auckland, Aotearoa, New Zealand
| | - Nicole Rankin
- Evaluation and Implementation Science Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Adam Fusheini
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | - Rachel Brown
- National Hauora Coalition, Auckland, Aotearoa, New Zealand
| | | | - Mihi Ratima
- Taumata Associates, Hāwera, Aotearoa, New Zealand
| | - Patricia Priest
- Preventive and Social Medicine, University of Otago, Dunedin Campus, Dunedin, Aotearoa, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin Campus, Dunedin, Aotearoa, PO Box 56, 9054, New Zealand.
| |
Collapse
|
7
|
Zhang C, Mathur AK. Breaking Barriers and Bridging Gaps: Advancing Diversity, Equity, and Inclusion in Kidney Transplant Care for Black and Hispanic Patients in the United States. Transpl Int 2023; 36:11455. [PMID: 37829616 PMCID: PMC10565005 DOI: 10.3389/ti.2023.11455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023]
Abstract
Kidney transplantation offers better mortality and quality of life outcomes to patients with end-stage renal failure compared to dialysis. Specifically, living donor kidney transplantation is the best treatment for end-stage renal disease, since it offers the greatest survival benefit compared to deceased donor kidney transplant or dialysis. However, not all patients from all racial/ethnic backgrounds enjoy these benefits. While black and Hispanic patients bear the predominant disease burden within the United States, they represent less than half of all kidney transplants in the country. Other factors such as cultural barriers that proliferate myths about transplant, financial costs that impede altruistic donation, and even biological predispositions create a complex maze and can also perpetuate care inaccessibility. Therefore, blanket efforts to increase the overall donation pool may not extend access to vulnerable populations, who may require more targeted attention and interventions. This review uses US kidney transplantation data to substantiate accessibility differences amongst racial minorities as well as provides examples of successful institutional and national systemic level changes that have improved transplantation outcomes for all.
Collapse
Affiliation(s)
- Chi Zhang
- Mayo Clinic Arizona, Phoenix, AZ, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | | |
Collapse
|
8
|
Wray J, Kim JS, Marks SD. Cultural and other beliefs as barriers to pediatric solid organ transplantation. Pediatr Transplant 2023; 27 Suppl 1:e14337. [PMID: 36468332 DOI: 10.1111/petr.14337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/06/2022] [Accepted: 04/15/2022] [Indexed: 12/12/2022]
Abstract
Organ shortage for transplantation is a global problem for both adult and pediatric recipients and this is particularly apparent in certain areas of the world and within specific communities. Cultural and religious beliefs can influence both a decision by a potential donor and/or their family to donate as well as a potential recipient's or their family's decision to accept the need for transplantation, agree to be listed and accept an organ. Globally, there are cultural and religious diversities that can present significant challenges for the transplant professional, particularly those whose practice is based in multicultural communities. In the pediatric population, in particular, barriers to organ transplantation related to culture and religion have not been well-described, with resulting implications for how they should or could be effectively addressed. Therefore, this review was undertaken to elucidate cultural and religious barriers to pediatric organ transplantation and, where feasible, to identify facilitators and strategies for overcoming these barriers.
Collapse
Affiliation(s)
- Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Ji Soo Kim
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK.,Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Stephen D Marks
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK.,Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
9
|
Ho EW, Murillo AL, Davis LA, Iraheta YA, Advani SM, Feinsinger A, Waterman AD. Findings of living donation experiences shared on a digital storytelling platform: A thematic analysis. PEC INNOVATION 2022; 1:100023. [PMID: 37213721 PMCID: PMC10194229 DOI: 10.1016/j.pecinn.2022.100023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/28/2022] [Accepted: 02/13/2022] [Indexed: 05/23/2023]
Abstract
Objectives To identify common experiences and emotional changes shared by living donors and kidney recipients about their living donation experiences on a digital storytelling platform. Methods 82 donors and 36 recipients submitted prompt-guided videos to the platform. Two coders analyzed transcripts for motivations, common themes, and emotions expressed. Results Storytellers shared their stories to advocate for living donation and contribute to others facing similar challenges. Pre-surgery, recipients recalled their dialysis experiences and how they sought living donors while donors discussed their motivations and common fears. Post-surgery, recipients discussed changes in their relationship with the donor and quality life, while donors described how they benefited. Learning they needed a transplant, recipients reported feeling fear (33.3%) while donors felt sadness (48.8%). Post-transplant, recipients and donors reported feeling happiness (85.4%, 38.9%) and relief (29.3%, 22.2%). Conclusion Online digital storytelling libraries increase access to real-life living donation experiences. Since stories are highly personal, additional living donor kidney transplant risk-benefit education is needed. Innovation Stories can supplement traditional education and be incorporated into advocacy efforts; campaigns could capitalize upon the personal aspect of stories to gently introduce and encourage living kidney donation among the general public.
Collapse
Affiliation(s)
- Erica W. Ho
- Terasaki Institute for Biomedical Innovation, 1018 Westwood Blvd, Los Angeles, CA, USA
| | - Ariana L. Murillo
- David Geffen School of Medicine, 886 Tiverton Ave, Los Angeles, CA, USA
| | - LaShara A. Davis
- Center for Outcomes Research, Houston Methodist Hospital, 6565 Fannin St, Houston, TX, USA
| | | | - Shailesh M. Advani
- Terasaki Institute for Biomedical Innovation, 1018 Westwood Blvd, Los Angeles, CA, USA
| | - Ashley Feinsinger
- David Geffen School of Medicine, 886 Tiverton Ave, Los Angeles, CA, USA
| | - Amy D. Waterman
- Center for Outcomes Research, Houston Methodist Hospital, 6565 Fannin St, Houston, TX, USA
- Corresponding author at: Houston Methodist Hospital, 6565 Fannin St, Houston, TX 77030, USA.
| |
Collapse
|
10
|
Gordon EJ, Lee J, Kang R, Caicedo JC. Impact of having potential living donors on ethnic/racial disparities in access to kidney transplantation. Am J Transplant 2022; 22:2433-2442. [PMID: 35524363 PMCID: PMC9547969 DOI: 10.1111/ajt.17090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/10/2022] [Accepted: 05/03/2022] [Indexed: 01/25/2023]
Abstract
Racial/ethnic disparities persist in patients' access to living donor kidney transplantation (LDKT). This study assessed the impact of having available potential living donors (PLDs) on candidates' receipt of a kidney transplant (KT) and LDKT at two KT programs. Using data from our clinical trial of waitlisted candidates (January 1, 2014-December 31, 2019), we evaluated Hispanic and Non-Hispanic White (NHW) KT candidates' number of PLDs. Multivariable logistic regression assessed the impact of PLDs on transplantation (KT vs. no KT; for KT recipients, LDKT vs. deceased donor KT). A total of 847 candidates were included, identifying as Hispanic (45.8%) or NHW (54.2%). For Site A, both Hispanic (adjusted OR = 2.26 [95% CI 1.13-4.53]) and NHW (OR = 2.42 [1.10-5.33]) candidates with PLDs completing the questionnaire were more likely to receive a KT. For Site B, candidates with PLDs were not significantly more likely to receive KT. Among KT recipients at both sites, Hispanic (Site A: OR = 21.22 [2.44-184.88]; Site B: OR = 25.54 [7.52-101.54]), and NHW (Site A: OR = 37.70 [6.59-215.67]; Site B: OR = 15.18 [5.64-40.85]) recipients with PLD(s) were significantly more likely to receive a LDKT. Our findings suggest that PLDs increased candidates' likelihood of KT receipt, particularly LDKT. Transplant programs should help candidates identify PLDs early in transplant evaluation.
Collapse
Affiliation(s)
- Elisa J. Gordon
- Department of Surgery‐ Division of TransplantationCenter for Health Services and Outcomes ResearchCenter for Bioethics and Medical HumanitiesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jungwha Lee
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Raymond Kang
- Center for Community HealthNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Juan Carlos Caicedo
- Department of Surgery‐ Division of TransplantationNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| |
Collapse
|
11
|
Alvarado F, Cervantes CE, Crews DC, Blanck J, Al Ammary F, Ng DK, Purnell TS. Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: A systematic review. Am J Transplant 2022; 22:1737-1753. [PMID: 35258164 PMCID: PMC9546009 DOI: 10.1111/ajt.17017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 01/25/2023]
Abstract
We conducted a systematic review to assess outcomes in Hispanic donors and explore how Hispanic ethnicity was characterized. We searched PubMed, EMBASE, and Scopus through October 2021. Two reviewers independently screened study titles, abstracts, and full texts; they also qualitatively synthesized results and independently assessed quality of included studies. Eighteen studies met our inclusion criteria. Study sample sizes ranged from 4007 to 143,750 donors and mean age ranged from 37 to 54 years. Maximum follow-up time of studies varied from a perioperative donor nephrectomy period to 30 years post-donation. Hispanic donors ranged between 6% and 21% of the donor populations across studies. Most studies reported Hispanic ethnicity under race or a combined race and ethnicity category. Compared to non-Hispanic White donors, Hispanic donors were not at increased risk for post-donation mortality, end-stage kidney disease, cardiovascular disease, non-pregnancy-related hospitalizations, or overall perioperative surgical complications. Compared to non-Hispanic White donors, most studies showed Hispanic donors were at higher risk for diabetes mellitus following nephrectomy; however, mixed findings were seen regarding the risk for post-donation chronic kidney disease and hypertension. Future studies should evaluate cultural, socioeconomic, and geographic differences within the heterogeneous Hispanic donor population, which may further explain variation in health outcomes.
Collapse
Affiliation(s)
- Flor Alvarado
- Section of Nephrology and HypertensionDepartment of MedicineTulane UniversityNew OrleansLouisinaUSA
| | - Carmen Elena Cervantes
- Division of NephrologyDepartment of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Deidra C. Crews
- Division of NephrologyDepartment of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Jamie Blanck
- Johns Hopkins Welch Medical LibraryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Fawaz Al Ammary
- Division of NephrologyDepartment of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA,Division of TransplantationDepartment of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Derek K. Ng
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Tanjala S. Purnell
- Welch Center for Prevention, Epidemiology and Clinical ResearchJohns Hopkins UniversityBaltimoreMarylandUSA,Division of TransplantationDepartment of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA,Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| |
Collapse
|
12
|
Gordon EJ, Uriarte JJ, Anderson N, Romo E, Caicedo JC, Shumate M. Implementation and modification of an organizational-level intervention: a prospective analysis. Implement Sci Commun 2022; 3:59. [PMID: 35659156 PMCID: PMC9164326 DOI: 10.1186/s43058-022-00296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background Modifications to interventions can jeopardize intervention outcomes. Pre-existing perceived barriers and facilitators to the intervention arising in the implementation preparation phase may help explain why modifications to the intervention may occur during the implementation phase. This two-site comparative case study describes modifications made to a complex organizational-level intervention and examines how known implementation science factors may have enabled such changes to occur. Methods Northwestern Medicine’sTM Hispanic Kidney Transplant Program (HKTP) is a culturally competent transplant center-based intervention designed to reduce disparities in living donor kidney transplantation among Hispanics. In-depth qualitative interviews and discussions were longitudinally conducted with transplant stakeholders (i.e., physicians, administrators, clinicians) at two kidney transplant programs with large Hispanic populations during implementation preparation and implementation phases. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis, and Stirman’s Framework for Reporting Adaptations and Modifications-Expanded (FRAME) guided modification classification. Results Across sites, 57 stakeholders participated in an interview, group discussion, and/or learning collaborative discussion. Site-B made more modifications than Site-A (n = 29 versus n = 18). Sites differed in the proportions of delaying/skipping (Site-A 50% versus Site-B 28%) and adding (Site-A 11% versus Site-B 28%) but had comparable substituting (Site-A 17% versus Site-B 17%) and tweaking (Site-A 17% versus Site-B 14%) modification types. Across sites, the transplant team consistently initiated the most modifications (Site-A 66%; Site-B 62%). While individuals initiated slightly more modifications at Site-B (21% versus Site-A 17%), institutions instigated proportionately slightly more modifications at Site-A (17% versus Site-B 10%). CFIR inner setting factors (i.e., structural characteristics, culture, available resources, implementation climate) that prominently emerged during the implementation preparation phase explained similarities and differences in sites’ modification numbers, types, and agents in the implementation phase. Conclusion Organizations implementing a culturally competent care intervention made modifications. CFIR inner setting factors emerging in the implementation preparation phase largely explained similarities and differences in study sites’ modifications. Identifying factors contributing to modifications may help institutions become better prepared to implement an intervention by addressing known factors in advance, which may foster greater fidelity leading to desired outcomes. Trial registration ClinicalTrials.govNCT03276390. We registered the study retrospectively on 9-7-17. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00296-0.
Collapse
Affiliation(s)
- Elisa J Gordon
- Department of Surgery - Division of Transplantation, Center for Health Services and Outcomes Research, Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA.
| | - Jefferson J Uriarte
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Naomi Anderson
- School of Education and Policy, Northwestern University, Evanston, IL, USA
| | - Elida Romo
- Department of Neurology - Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Juan Carlos Caicedo
- Department of Surgery - Division of Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michelle Shumate
- Department of Communication Studies, Northwestern University, Evanston, IL, USA
| |
Collapse
|
13
|
Sandal S, Horton A, Fortin MC. Advancing a Paradigm Shift to Approaching Health Systems in the Field of Living-Donor Kidney Transplantation: An Opinion Piece. Can J Kidney Health Dis 2022; 9:20543581221079486. [PMID: 35237443 PMCID: PMC8882925 DOI: 10.1177/20543581221079486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- The Metabolic Disorders and Complications Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Anna Horton
- The Metabolic Disorders and Complications Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Division of Nephrology, Department of Medicine, Centre hospitalier de l’Université de Montréal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, QC, Canada
| |
Collapse
|
14
|
Gordon EJ, Uriarte J, Lee J, Kang R, Shumate M, Ruiz R, Mathur AK, Ladner DP, Caicedo JC. Effectiveness of a culturally competent care intervention in reducing disparities in Hispanic live donor kidney transplantation: A hybrid trial. Am J Transplant 2022; 22:474-488. [PMID: 34559944 PMCID: PMC8813886 DOI: 10.1111/ajt.16857] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/30/2021] [Accepted: 09/15/2021] [Indexed: 02/03/2023]
Abstract
Hispanic patients receive disproportionately fewer living donor kidney transplants (LDKTs) than non-Hispanic Whites (NHWs). The Northwestern Medicine Hispanic Kidney Transplant Program (HKTP), designed to increase Hispanic LDKTs, was evaluated as a nonrandomized, implementation-effectiveness hybrid trial of patients initiating transplant evaluation at two intervention and two similar control sites. Using a mixed method, observational design, we evaluated the fidelity of the HKTP implementation at the two intervention sites. We tested the impact of the HKTP intervention by evaluating the likelihood of receiving LDKT comparing pre-intervention (January 2011-December 2016) and postintervention (January 2017-March 2020), across ethnicity and centers. The HKTP study included 2063 recipients. Intervention Site A exhibited greater implementation fidelity than intervention Site B. For Hispanic recipients at Site A, the likelihood of receiving LDKTs was significantly higher at postintervention compared with pre-intervention (odds ratio [OR] = 3.17 95% confidence interval [1.04, 9.63]), but not at the paired control Site C (OR = 1.02 [0.61, 1.71]). For Hispanic recipients at Site B, the likelihood of receiving an LDKT did not differ between pre- and postintervention (OR = 0.88 [0.40, 1.94]). The LDKT rate was significantly lower for Hispanics at paired control Site D (OR = 0.45 [0.28, 0.90]). The intervention significantly improved LDKT rates for Hispanic patients at the intervention site that implemented the intervention with greater fidelity. Registration: ClinicalTrials.gov registered (retrospectively) on September 7, 2017 (NCT03276390).
Collapse
Affiliation(s)
- Elisa J. Gordon
- Department of Surgery- Division of Transplantation, Center for Health Services and Outcomes Research, Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine
| | - Jefferson Uriarte
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine
| | - Jungwha Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine
| | - Raymong Kang
- Center for Community Health, Northwestern University Feinberg School of Medicine
| | - Michelle Shumate
- Delaney Family University Research Professor, Department of Communication Studies, Northwestern University
| | - Richard Ruiz
- Department of Surgery, Baylor University Medical Center
| | | | - Daniela P. Ladner
- Department of Surgery-Division of Transplantation, Northwestern University Feinberg School of Medicine
| | - Juan Carlos Caicedo
- Department of Surgery-Division of Transplantation, Northwestern University Feinberg School of Medicine
| |
Collapse
|
15
|
Urbanski MA, Wilk AS, Escoffery C, Patzer RE. Dissemination and Implementation Science: A Primer and Applications in Nephrology. KIDNEY360 2021; 3:185-189. [PMID: 35368559 PMCID: PMC8967602 DOI: 10.34067/kid.0005662021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/15/2021] [Indexed: 01/10/2023]
Affiliation(s)
- Megan A. Urbanski
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Adam S. Wilk
- Department of Health Policy and Management, Emory University, Atlanta, Georgia
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia
| | - Rachel E. Patzer
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia,Department of Epidemiology, Emory University, Atlanta, Georgia
| |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW Living organ donation provides improved access to transplantation, thereby shortening transplant wait times and allowing for more deceased organ transplants. However, disparity in access to living donation has resulted in decreased rates of living donor transplants for some populations of patients. RECENT FINDINGS Though there have been marked improvements in deceased donor equity, there are still challenges as it relates to gender, racial/ethnic, and socio-economic disparity. Improvements in living donation rates in Hispanic and Asian populations are tempered by challenges in African American rates of organ donation. Socio-economic disparity may drive gender disparities in organ donation resulting in disproportionate female living donors. Tailored approaches relating to language-specific interventions as well as directed educational efforts have helped mitigate disparity. Additionally, the use of apolipoprotein1 testing and modifications of glomerular filtration rate calculators may improve rates of African American donation. This review will evaluate recent data in living donor disparity as well as highlight successes in mitigating disparity. SUMMARY Though there are still challenges in living donor disparity, many efforts at tailoring education and access as well as modifying living donor evaluation and identifying systemic policy changes may result in improvements in living donation rates.
Collapse
Affiliation(s)
- Reynold I Lopez-Soler
- Section of Renal Transplantation, Edward Hines VA Jr. Hospital, Hines
- Department of Surgery, Division of Intra-Abdominal Transplantation, Stritch School of Medicine, Maywood, Illinois, USA
| | - Raquel Garcia-Roca
- Department of Surgery, Division of Intra-Abdominal Transplantation, Stritch School of Medicine, Maywood, Illinois, USA
| | - David D Lee
- Department of Surgery, Division of Intra-Abdominal Transplantation, Stritch School of Medicine, Maywood, Illinois, USA
| |
Collapse
|
17
|
Wilson EM, Chen A, Johnson M, Perkins JA, Purnell TS. Elucidating measures of systemic racism to mitigate racial disparities in kidney transplantation. Curr Opin Organ Transplant 2021; 26:554-559. [PMID: 34456271 DOI: 10.1097/mot.0000000000000913] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Given recent national attention to the role of racism in perpetuating racial inequities in society and health, this review provides a timely and relevant summary of key measures of systemic racism in kidney transplantation. More specifically, the review identifies current and promising interventions, whereas highlighting the need for more sustainable and impactful interventions. RECENT FINDINGS Racial disparities persist in kidney transplantation. Black and Hispanic individuals are less likely to receive a kidney transplant than non-Hispanic Whites despite disproportionately higher rates of kidney failure. Studies demonstrate that socioeconomic factors do not fully explain existing racial disparities in transplantation. Systemic racism at all levels, individual, interpersonal, institutional, and structural, is at the core of racial disparities, and current interventions are insufficient in mitigating their effects. Thus, targeted and sustainable interventions must be implemented to mitigate systemic racism in kidney transplantation. SUMMARY Systemic racism in all its forms continues to influence disparities at all stages of kidney transplantation. This paper highlights recent findings that shed light on how racism contributes to racial disparities in kidney transplantation. Using these findings to identify targets and strategies for mitigation, relevant interventions and policies that show promise are detailed.
Collapse
Affiliation(s)
- Elena M Wilson
- Epidemiology Research Group in Organ Transplantation, Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andy Chen
- Epidemiology Research Group in Organ Transplantation, Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Morgan Johnson
- Epidemiology Research Group in Organ Transplantation, Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Columbia University Mailman School of Public Health, New York City, New York
| | - Jamilah A Perkins
- Epidemiology Research Group in Organ Transplantation, Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tanjala S Purnell
- Epidemiology Research Group in Organ Transplantation, Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
18
|
Gordon EJ, Romo E, Amórtegui D, Rodas A, Anderson N, Uriarte J, McNatt G, Caicedo JC, Ladner DP, Shumate M. Implementing culturally competent transplant care and implications for reducing health disparities: A prospective qualitative study. Health Expect 2020; 23:1450-1465. [PMID: 33037746 PMCID: PMC7752187 DOI: 10.1111/hex.13124] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite available evidence-based interventions that decrease health disparities, these interventions are often not implemented. Northwestern Medicine's® Hispanic Kidney Transplant Program (HKTP) is a culturally and linguistically competent intervention designed to reduce disparities in living donor kidney transplantation (LDKT) among Hispanics/Latinos. The HKTP was introduced in two transplant programs in 2016 to evaluate its effectiveness. OBJECTIVE This study assessed barriers and facilitators to HKTP implementation preparation. METHODS Interviews and group discussions were conducted with transplant stakeholders (ie administrators, nurses, physicians) during implementation preparation. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis. RESULTS Forty-four stakeholders participated in 24 interviews and/or 27 group discussions. New factors, not found in previous implementation preparation research in health-care settings, emerged as facilitators and barriers to the implementation of culturally competent care. Implementation facilitators included: stakeholders' focus on a moral imperative to implement the HKTP, personal motivations related to their Hispanic heritage, and perceptions of Hispanic patients' transplant education needs. Implementation barriers included: stakeholders' perceptions that Hispanics' health insurance payer mix would negatively impact revenue, a lack of knowledge about LDKT disparities and patient data disaggregated by ethnicity/race, and a perception that the family discussion component was immoral because of the possibility of coercion. DISCUSSION AND CONCLUSIONS Our study identified novel barriers and facilitators to the implementation preparation of a culturally competent care intervention. Healthcare administrators can facilitate organizations' implementation of culturally competent care interventions by understanding factors challenging care delivery processes and raising clinical team awareness of disparities in LDKT.
Collapse
Affiliation(s)
- Elisa J. Gordon
- Division of Transplantation, Department of SurgeryNorthwestern MedicineChicagoILUSA
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of MedicineChicagoILUSA
- Center for Health Services and Outcomes ResearchNorthwestern University Feinberg School of MedicineChicagoILUSA
- Center for Bioethics and Medical HumanitiesNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Elida Romo
- Center for Health Services and Outcomes ResearchNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Daniela Amórtegui
- Center for Health Services and Outcomes ResearchNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Alejandra Rodas
- Center for Health Services and Outcomes ResearchNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Naomi Anderson
- Center for Health Services and Outcomes ResearchNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Jefferson Uriarte
- Center for Health Services and Outcomes ResearchNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Gwen McNatt
- Kovler Organ Transplant CenterNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Juan Carlos Caicedo
- Division of Transplantation, Department of SurgeryNorthwestern MedicineChicagoILUSA
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of MedicineChicagoILUSA
| | - Daniela P. Ladner
- Division of Transplantation, Department of SurgeryNorthwestern MedicineChicagoILUSA
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of MedicineChicagoILUSA
| | - Michelle Shumate
- Department of Communication StudiesNorthwestern UniversityChicagoILUSA
| |
Collapse
|