Center for Reducing Health Disparities, Department of Medicine, Case Western Reserve University, Cleveland, OH 44109, USA.
Clin J Am Soc Nephrol. 2012 Oct;7(10):1639-45. doi: 10.2215/CJN.11731111. Epub 2012 Jul 12.
Many patients with ESRD, particularly minorities and women, face barriers in completing the steps required to obtain a transplant. These eight sequential steps are as follows: medical suitability, interest in transplant, referral to a transplant center, first visit to center, transplant workup, successful candidate, waiting list or identify living donor, and receive transplant. This study sought to determine the effect of navigators on completion of steps.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Cluster randomized, controlled trial at 23 Ohio hemodialysis facilities. One hundred sixty-seven patients were recruited between January 2009 and August 2009 and were followed for up to 24 months or until study end in February 2011. Trained kidney transplant recipients met monthly with intervention participants (n=92), determined their step in the transplant process, and provided tailored information and assistance in completing the step. Control participants (n=75) continued to receive usual care. The primary outcome was the number of transplant process steps completed.
Starting step did not significantly differ between the two groups. By the end of the trial, intervention participants completed more than twice as many steps as control participants (3.5 versus 1.6 steps; difference, 1.9 steps; 95% confidence interval, 1.3-2.5 steps). The effect of the intervention on step completion was similar across race and sex subgroups.
Use of trained transplant recipients as navigators resulted in increased completion of transplant process steps.
许多终末期肾病患者，尤其是少数民族和女性患者，在完成获得移植所需的八个连续步骤时面临障碍。这八个步骤如下：医学适宜性、对移植的兴趣、转诊到移植中心、首次到中心就诊、移植检查、成为合格候选人、等待名单或寻找活体供者，以及接受移植。本研究旨在确定导航员对完成步骤的影响。
设计、设置、参与者和测量：在俄亥俄州的 23 家血液透析机构进行了一项集群随机对照试验。2009 年 1 月至 2009 年 8 月期间，招募了 167 名患者，并对其进行了长达 24 个月的随访，或直至 2011 年 2 月研究结束。接受过肾脏移植的受训患者每月与干预组参与者（n=92）会面，确定他们在移植过程中的步骤，并提供完成该步骤的个性化信息和帮助。对照组参与者（n=75）继续接受常规护理。主要结果是完成移植过程步骤的数量。
两组开始时的步骤没有显著差异。在试验结束时，干预组参与者完成的步骤数是对照组参与者的两倍多（3.5 步与 1.6 步；差异 1.9 步；95%置信区间 1.3-2.5 步）。干预对步骤完成的影响在种族和性别亚组中相似。
使用经过培训的移植受者作为导航员可增加移植过程步骤的完成。
