Implementation of the ASCENT Trial to Improve Transplant Waitlisting Access

dc.contributor.authorUrbanski, Megan
dc.contributor.authorLee, Yi-Ting Hana
dc.contributor.authorEscoffery, Cam
dc.contributor.authorBuford, Jade
dc.contributor.authorPlantinga, Laura
dc.contributor.authorPastan, Stephen O.
dc.contributor.authorHamoda, Reem
dc.contributor.authorBlythe, Emma
dc.contributor.authorPatzer, Rachel E.
dc.contributor.departmentSurgery, School of Medicine
dc.date.accessioned2024-06-11T11:45:58Z
dc.date.available2024-06-11T11:45:58Z
dc.date.issued2023-11-02
dc.description.abstractIntroduction: The Allocation System for changes in Equity in Kidney Transplantation (ASCENT) study was a hybrid type 1 trial of a multicomponent intervention among 655 US dialysis facilities with low kidney transplant waitlisting to educate staff and patients about kidney allocation system (KAS) changes and increase access to and reduce racial disparities in waitlisting. Intervention components included a staff webinar, patient and staff educational videos, and facility-specific feedback reports. Methods: Implementation outcomes were assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework. Postimplementation surveys were administered among intervention group facilities (n = 334); interviews were conducted with facility staff (n = 6). High implementation was defined as using 3 to 4 intervention components, low implementation as using 1 to 2 components, and nonimplementation as using no components. Results: A total of 331 (99%) facilities completed the survey; 57% were high implementers, 31% were low implementers, and 12% were nonimplementers. Waitlisting events were higher or similar among high versus low implementer facilities for incident and prevalent populations; for Black incident patients, the mean proportion waitlisted in low implementer facilities was 0.80% (95% confidence interval [CI]: 0.73-0.87) at baseline and 0.55% at 1-year (95% CI: 0.48-0.62) versus 0.83% (95% CI: 0.78-0.88) at baseline and 1.40% at 1-year (95% CI: 1.35-1.45) in high implementer facilities. Interviews revealed that the intervention helped facilities prioritize transplant education, but that intervention components were not uniformly shared. Conclusion: The findings provide important context to interpret ASCENT effectiveness results and identified key barriers and facilitators to consider for future modification and scale-up of multilevel, multicomponent interventions in dialysis settings.
dc.eprint.versionFinal published version
dc.identifier.citationUrbanski M, Lee YH, Escoffery C, et al. Implementation of the ASCENT Trial to Improve Transplant Waitlisting Access. Kidney Int Rep. 2023;9(2):225-238. Published 2023 Nov 2. doi:10.1016/j.ekir.2023.10.028
dc.identifier.urihttps://hdl.handle.net/1805/41395
dc.language.isoen_US
dc.publisherElsevier
dc.relation.isversionof10.1016/j.ekir.2023.10.028
dc.relation.journalKidney International Reports
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internationalen
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0
dc.sourcePMC
dc.subjectDialysis
dc.subjectDisparities
dc.subjectImplementation science
dc.subjectKidney allocation system
dc.subjectKidney transplant
dc.subjectMulticomponent intervention
dc.titleImplementation of the ASCENT Trial to Improve Transplant Waitlisting Access
dc.typeArticle
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