ASCENT（肾脏移植公平性分配系统变革）研究：一项旨在改善肾脏移植等待名单并减少种族差异的随机有效性-实施研究。
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.
作者信息
Patzer Rachel E, Smith Kayla, Basu Mohua, Gander Jennifer, Mohan Sumit, Escoffery Cam, Plantinga Laura, Melanson Taylor, Kalloo Sean, Green Gary, Berlin Alex, Renville Gary, Browne Teri, Turgeon Nicole, Caponi Susan, Zhang Rebecca, Pastan Stephen
机构信息
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.
出版信息
Kidney Int Rep. 2017 May;2(3):433-441. doi: 10.1016/j.ekir.2017.02.002. Epub 2017 Feb 9.
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.
引言
器官共享联合网络（UNOS）于2014年12月实施了一项新的肾脏分配系统（KAS），预计该系统将大幅减少等待名单上患者在肾脏移植方面的种族差异。然而，并非所有透析设施的临床提供者和终末期肾病（ESRD）患者都了解这一政策变化如何能改善移植机会。
方法
我们描述了ASCENT（肾脏移植公平性分配系统变革）研究，这是一项随机对照有效性-实施研究，旨在测试一项多组分干预措施在美国各地透析设施中改善肾脏移植早期步骤获取机会的有效性。多组分干预措施包括为透析医疗主任举办的教育网络研讨会、为患者制作的教育视频、为透析工作人员制作的教育视频以及一份针对透析设施的特定移植表现反馈报告。这些材料将由一个多学科传播咨询委员会开发，并将在美国各地的透析设施中进行形成性测试。
结果
估计这项研究将纳入美国所有18个ESRD网络中等待名单排名较低的约600家透析设施。共同主要结局包括等待名单的变化以及1年后等待名单的差异；次要结局包括设施医疗主任对KAS的知识变化、工作人员关于KAS的培训、患者关于移植的教育以及医疗主任将患者转介进行移植评估的意向。
结论
ASCENT研究的结果将证明一项旨在增加进入 deceased-donor 肾脏等待名单的机会并减少等待名单上种族差异的多组分干预措施的可行性和有效性。
Zotero 插件