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A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol.
BMC Health Serv Res. 2018 05 16; 18(1):368.BH

Abstract

BACKGROUND

The shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans in the United States. Living donor kidney transplantation (LDKT) is the treatment of choice for ESRD. However, compared to their representation on the transplant waitlist, fewer Hispanics receive a LDKT than non-Hispanic whites. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and language barriers. Few interventions have been designed to reduce LDKT disparities. This study aims to reduce Hispanic disparities in LDKT through a culturally targeted intervention.

METHODS/DESIGN

Using a prospective effectiveness-implementation hybrid design involving pre-post intervention evaluation with matched controls, we will implement a complex culturally targeted intervention at two transplant centers in Dallas, TX and Phoenix, AZ. The goal of the study is to evaluate the effect of Northwestern Medicine's® Hispanic Kidney Transplant Program's (HKTP) key culturally targeted components (outreach, communication, education) on Hispanic LDKT rates over five years. The main hypothesis is that exposure to the HKTP will reduce disparities by increasing the ratio of Hispanic to non-Hispanic white LDKTs and the number of Hispanic LDKTs. We will also examine other process and outcome measures including: dialysis patient outreach, education session attendance, marketing efforts, Hispanic patients added to the waitlist, Hispanic potential donors per potential recipient, and satisfaction with culturally competent care. We will use mixed methods based on the Promoting Action on Research Implementation in Health Services (revised PARIHS) and the Consolidated Framework for Implementation Research (CFIR) frameworks to formatively evaluate the fidelity and innovative adaptations to HKTP's components at both study sites, to identify moderating factors that most affect implementation fidelity, and to identify adaptations that positively and negatively affect outcomes for patients.

DISCUSSION

Our study will provide new knowledge about implementing culturally targeted interventions and their impact on reducing health disparities. Moreover, the study of a complex organizational-level intervention's implementation over five years is rare in implementation science; as such, this study is poised to contribute new knowledge to the factors influencing how organizational-level interventions are sustained over time.

TRIAL REGISTRATION

(ClinicalTrials.gov registration # NCT03276390 , date of registration: 9-7-17, retrospectively registered).

Authors+Show Affiliations

Department of Surgery-Division of Transplantation, Center for Healthcare Studies, Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th FL, Chicago, IL, 60611, USA. e-gordon@northwestern.edu.Preventive Medicine and Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.Center for Healthcare Studies, Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th FL, Chicago, IL, 60611, USA.Department of Surgery-Division of Transplantation, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, 19th FL, Chicago, IL, 60611, USA.Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th FL, Chicago, IL, 60611, USA.Department of Surgery-Division of Transplantation, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, 19th FL, Chicago, IL, 60611, USA.Department of Communication Studies, Northwestern University, 240 Campus Drive, Rm 2-118, Evanston, IL, 60208, USA.

Pub Type(s)

Controlled Clinical Trial
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29769080

Citation

Gordon, Elisa J., et al. "A Complex Culturally Targeted Intervention to Reduce Hispanic Disparities in Living Kidney Donor Transplantation: an Effectiveness-implementation Hybrid Study Protocol." BMC Health Services Research, vol. 18, no. 1, 2018, p. 368.
Gordon EJ, Lee J, Kang RH, et al. A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol. BMC Health Serv Res. 2018;18(1):368.
Gordon, E. J., Lee, J., Kang, R. H., Caicedo, J. C., Holl, J. L., Ladner, D. P., & Shumate, M. D. (2018). A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol. BMC Health Services Research, 18(1), 368. https://doi.org/10.1186/s12913-018-3151-5
Gordon EJ, et al. A Complex Culturally Targeted Intervention to Reduce Hispanic Disparities in Living Kidney Donor Transplantation: an Effectiveness-implementation Hybrid Study Protocol. BMC Health Serv Res. 2018 05 16;18(1):368. PubMed PMID: 29769080.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol. AU - Gordon,Elisa J, AU - Lee,Jungwha, AU - Kang,Raymond H, AU - Caicedo,Juan Carlos, AU - Holl,Jane L, AU - Ladner,Daniela P, AU - Shumate,Michelle D, Y1 - 2018/05/16/ PY - 2017/12/07/received PY - 2018/04/25/accepted PY - 2018/5/18/entrez PY - 2018/5/18/pubmed PY - 2018/11/27/medline KW - Complex interventions KW - End-stage kidney disease KW - Equity KW - Health disparities KW - Hybrid study KW - Implementation science KW - Organizational-level intervention SP - 368 EP - 368 JF - BMC health services research JO - BMC Health Serv Res VL - 18 IS - 1 N2 - BACKGROUND: The shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans in the United States. Living donor kidney transplantation (LDKT) is the treatment of choice for ESRD. However, compared to their representation on the transplant waitlist, fewer Hispanics receive a LDKT than non-Hispanic whites. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and language barriers. Few interventions have been designed to reduce LDKT disparities. This study aims to reduce Hispanic disparities in LDKT through a culturally targeted intervention. METHODS/DESIGN: Using a prospective effectiveness-implementation hybrid design involving pre-post intervention evaluation with matched controls, we will implement a complex culturally targeted intervention at two transplant centers in Dallas, TX and Phoenix, AZ. The goal of the study is to evaluate the effect of Northwestern Medicine's® Hispanic Kidney Transplant Program's (HKTP) key culturally targeted components (outreach, communication, education) on Hispanic LDKT rates over five years. The main hypothesis is that exposure to the HKTP will reduce disparities by increasing the ratio of Hispanic to non-Hispanic white LDKTs and the number of Hispanic LDKTs. We will also examine other process and outcome measures including: dialysis patient outreach, education session attendance, marketing efforts, Hispanic patients added to the waitlist, Hispanic potential donors per potential recipient, and satisfaction with culturally competent care. We will use mixed methods based on the Promoting Action on Research Implementation in Health Services (revised PARIHS) and the Consolidated Framework for Implementation Research (CFIR) frameworks to formatively evaluate the fidelity and innovative adaptations to HKTP's components at both study sites, to identify moderating factors that most affect implementation fidelity, and to identify adaptations that positively and negatively affect outcomes for patients. DISCUSSION: Our study will provide new knowledge about implementing culturally targeted interventions and their impact on reducing health disparities. Moreover, the study of a complex organizational-level intervention's implementation over five years is rare in implementation science; as such, this study is poised to contribute new knowledge to the factors influencing how organizational-level interventions are sustained over time. TRIAL REGISTRATION: (ClinicalTrials.gov registration # NCT03276390 , date of registration: 9-7-17, retrospectively registered). SN - 1472-6963 UR - https://www.unboundmedicine.com/medline/citation/29769080/A_complex_culturally_targeted_intervention_to_reduce_Hispanic_disparities_in_living_kidney_donor_transplantation:_an_effectiveness_implementation_hybrid_study_protocol_ DB - PRIME DP - Unbound Medicine ER -