A Culturally Targeted Transplant Program
Condition: ESRD
Study type: Interventional

Summary: 
      Hispanic/Latino patients with end-stage renal disease are disproportionately less likely to
      get a kidney transplant, and specifically, a living donor kidney transplant (LDKT), compared
      to non-Hispanic whites. Accordingly, without LDKTs, Hispanics experience longer transplant
      waiting times, shorter patient and graft survival, and worse quality of life. Cultural
      beliefs and linguistic barriers contribute to the disparity in LDKTs. The objective of the
      proposed study is to implement and evaluate Northwestern Medicine's® Hispanic Kidney
      Transplant Program, a culturally-competent transplant center-based intervention, at two
      transplant centers serving large Hispanic populations. The proposed study will provide
      valuable knowledge about the potential to rapidly disseminate the HKTP as a novel approach to
      increase Hispanic LDKTs nationally.
    

Detailed description: 
      The shortage of organs for kidney transplantation for patients with end-stage renal disease
      (ESRD) is magnified in Hispanics/Latin Americans. Hispanics have a disproportionately higher
      prevalence of ESRD, yet receive fewer kidney transplants compared to non-Hispanic whites.
      Living donor kidney transplant (LDKT) is the treatment of choice for ESRD as it confers
      better patient and graft survival, shorter waiting time, and better quality of life than
      deceased donor kidney transplantation. However, compared to their representation on the
      waiting list, fewer Hispanics received a LDKT than non-Hispanic whites in 2013: 4% versus
      10%. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and
      language barriers. The disparity will likely worsen without intervention as Hispanics are the
      largest and fastest growing minority group in the US.

      Few available culturally competent interventions have led to increased LDKT rates.
      Interventions rarely address Hispanic cultural concerns, and there are no published models of
      transplant center-based only programs. The Chicago Northwestern Medicine's® Hispanic Kidney
      Transplant Program (HKTP), a culturally and linguistically competent program, has increased
      Hispanic LDKTs. The mean annual ratio of Hispanic to non-Hispanic white LDKTs grew from 0.20
      in 2001-2006 to 0.34 in 2008-2013, a 70% increase (p<0.001).

      The objective of this study is to implement and evaluate the HKTP, a culturally-competent
      transplant center-based intervention, at two transplant centers serving large Hispanic
      populations (Dallas, TX, and Los Angeles, CA), with Northwestern University serving as the
      Study Coordinating Center. The pre-post HKTP intervention study will evaluate the effect of
      the HKTP's key culturally sensitive components (outreach, communication, education) on
      Hispanic LDKT rates, compared to matched controls. The specific aims are to:

        1. Implement the HKTP at two transplant centers by conducting a needs assessment of
           barriers and using a "learning collaborative" model to deliver HKTP protocols, scripts,
           and materials.

        2. Conduct a pre-post HKTP intervention evaluation with matched controls to assess if the
           HKTP is associated with an increase in: a) the ratio of Hispanic to non-Hispanic white
           LDKTs as a function of an absolute increase in Hispanic LDKTs, b) ESRD Hispanic patient
           additions to the waiting list, c) Hispanic potential donors per potential recipient, and
           d) Hispanic patients' satisfaction with care.

        3. Formatively evaluate the fidelity and innovative adaptations to HKTP's outreach,
           communication, and education at both study sites to identify effective components of the
           HTKP, using mixed methods.

      As an exploratory aim, a budget impact analysis will be conducted to construct a business
      case for transplant centers and permit estimates of HKTP scalability. The proposed study will
      provide valuable knowledge about the potential to rapidly disseminate the HKTP as a novel
      approach to increase Hispanic LDKTs nationally, improve health outcomes for Hispanics, and
      close the LDKT disparity gap.
    

Intervention name(s): Hispanic Kidney Transplant Program (HKTP)
Intervention type(s): Behavioral
Intervention description(s): The HKTP entails culturally targeted education in Spanish about transplantation, outreach to dialysis patients by bicultural health care providers.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: Two group comparison (intervention vs. control) and pre-post comparison (within each site).
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: health disparities; living donation