Upload
ciara-faulkner
View
33
Download
2
Embed Size (px)
DESCRIPTION
Minority Affairs Committee Report. OPTN/UNOS Board of Directors Meeting June 25-26, 2012 Silas P. Norman, MD Chairman. Minority Affairs Committee Update. Educational Guidelines on Patient Referral to Kidney Transplantation Ongoing CPRA Analysis Minority Donor Conversion Data Review - PowerPoint PPT Presentation
Citation preview
Minority Affairs Committee Report
OPTN/UNOS Board of Directors MeetingJune 25-26, 2012
Silas P. Norman, MDChairman
Minority Affairs Committee Update
Educational Guidelines on Patient Referral to Kidney Transplantation
Ongoing CPRA Analysis
Minority Donor Conversion Data Review
New Proposed MAC Projects
MAC - To increase access and transplants among minority populations
NOTA – Increase access, equitable allocation OPTN Strategic Goal – Increase the number of
transplants Significant challenge is timely access to kidney
transplant referrals
Educational Guidelines on Patient Referral to Kidney Transplantation
The majority of patients have seen a nephrologist < 12 months at the time they initiate dialysis
Many patients spend significant time on dialysis prior to referral for kidney transplant evaluation
Minority populations tend to be referred later for kidney transplant evaluation
The result is few pre-emptive transplants and excess patient mortality
Background
Access to Evaluation
CKD and ESRD patients need increased access to kidney transplant evaluation
The lack of timely evaluations directly impacts the ultimate number of transplants
We assume that with the proper information and incentives, providers and patients would improve timely referrals
What Is the Need?Provider Education
Providers must: understand the allocation system well enough to
care for patients. understand what constitutes timely referral. understand the need for timely referral. understand barriers to timely referral. be able to deliver/refer patients to accurate
transplant information.
Patient EducationPatients must:
understand the allocation system well enough to advocate for themselves.
understand what constitutes timely referral. understand the need for timely referral. understand barriers to timely referral. be able to locate sources of accurate transplant
information.
What Is the Need?
The default pathway for CKD and ESRD patients should be transplant referral
Preemptive transplant is the goal and can only be achieved with “early” referral
Education about transplant has to begin long before ESRD (Stage 3-4 CKD) to be most effective
Key Points
Abstracts presented at recent American Transplant Congress meeting highlighted:
Impact of early transplant education on outcomes Patients presented to transplant evaluation without
prior education were less likely to be transplanted Impact of external structural environment on access
Poverty, geography, etc. impact on referral and transplant
ATC
Improved patient outcomes
Minimizing extra work
CKD Stage 4 education reimbursement
Incentives
12+ months in the making
Subcommittee of the MAC Subsequently reviewed by full committee Expanded review in progress
Guidelines seek to educate providers about allocation, barriers and consequences of late referral
Guidelines provide direction for timely education and referral
Draft Guidelines
Representatives from professional transplant partner organizations AST NKF/KDOQUI STSW
OPTN Committees Kidney Patient Affairs Living Donor Transplant Administrators
Joint MAC/Organizational Representatives MOTTEP ASN AMAT
Expanded (Joint) Subcommittee
Review of draft document Major missing topic areas Major errors
Dissemination plan Identifying target groups/stakeholder groups Thinking about the best way to reach groups Minimizing duplication of efforts of other committees/groups
Expanded (Joint) Subcommittee
Guidelines Document Sections Purpose Background Kidney Function Interest in Transplant Co-morbid Conditions Medical Non-Adherence Substance Abuse Cognitive Impairment
Financial Status
Transplant Evaluation
Living Kidney Donation
Multiple Wait Listing
Barriers to Transplantation
Transplant Education
FAQ’s
Information Resources
References
Feedback from participants: Consensus building within their constituent groups Key contacts Media suggestions Educational strategies
Input/review to be solicited from: HRSA/CMS KDOQUI/KDIGO Board Internal UNOS staff
Timeline
Dissemination of the Guidelines
Development of Implementation Strategy
Development of Educational Initiatives
Development of Patient Friendly Version of Guidelines
Future Activities
Evaluation of Calculated PRA (CPRA) Policy for Allocation of Deceased Donor Kidneys: Transplant
Rates by Ethnicity and Sensitization Level
Adult Kidney Registrations as of 2/10/12 38% White, 34% Black, 18% Hispanic, 7% Asian and
2% other ethnicities
16% -- CPRA value of 80-100%
9.8% waiting with current CPRA ≥ 98% 43% were Black 35% White 14% Hispanic 6% Asian 2% other ethnicities
TX Rate Changes Post Policy Implementation
Significant decrease for non-sensitized (CPRA 0%) and low sensitized (CPRA 1-20%) White, Black, and Hispanic candidates
Significant increase for White, Black, and Asian moderately sensitized (CPRA 21-79%) candidates
No significant change among American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, or Multiracial candidates, regardless of sensitization level
Changes in TX Rates Significant increase for highly sensitized (CPRA 80-
100%) White, Black, and Hispanic candidates
Significant increase among White, Black, and Hispanic candidates with a CPRA of 80-97%, but decrease (although not significant) in transplant rates for those with CPRA of 98-100%
Also true for Asian candidates, although the decrease in transplant rates for those candidates with CPRA ≥ 98% was significant
Eligible Donor Conversion RatesBy Region and Ethnicity
Eligible Donor Conversion Rates, 2/1/08-11/30/11by Year: All Regions
Eligible Donor Conversion Rates, 2/1/08-11/30/11by Donor Ethnicity: All Regions
Eligible Donor Conversion Rates 2/1/08-11/30/11By Year and Ethnicity: All Regions
Results Across all regions and donor ethnicities the donor
conversion rate was 70.1% It ranged from 67% in 2008 to 73% in 2011
Overall conversion rate was the highest among donors of multiracial ethnicity (85%), followed by:
White donors (78%) Hispanics (67%) Blacks (55%) Asians (48%) Native Hawaiians/other Pacific Islanders (46%) American Indians/Alaska Natives (40%)
Results
Within each region, eligible donor conversion rates varied among donor ethnic groups.
Regions 4 and 6 seemed to have increasing conversion rates across different donor ethnic groups during 2008-2011.
New Proposed Committee Projects
Survey on Referral to Heart Transplantation
Study of Best Practices in Minority Donor Conversions
Deanna L. Parker, MPA
Wida Cherikh, Ph.D
Special Thanks