1 / 28

Minority Affairs Committee Report

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

ciara-faulkner
Télécharger la présentation

Minority Affairs Committee Report

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Minority Affairs Committee Report OPTN/UNOS Board of Directors Meeting June 25-26, 2012 Silas P. Norman, MD Chairman

  2. Minority Affairs Committee Update • Educational Guidelines on Patient Referral to Kidney Transplantation • Ongoing CPRA Analysis • Minority Donor Conversion Data Review • New Proposed MAC Projects

  3. Educational Guidelines on Patient Referral to Kidney Transplantation • 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

  4. Background • 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

  5. 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

  6. 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.

  7. What Is the Need? Patient Education Patients 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.

  8. Key Points • 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

  9. ATC • 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

  10. Incentives • Improved patient outcomes • Minimizing extra work • CKD Stage 4 education reimbursement

  11. Draft Guidelines • 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

  12. Expanded (Joint) Subcommittee • 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

  13. 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

  14. 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

  15. Timeline • 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

  16. Future Activities • Dissemination of the Guidelines • Development of Implementation Strategy • Development of Educational Initiatives • Development of Patient Friendly Version of Guidelines

  17. Evaluation of Calculated PRA (CPRA) Policy for Allocation of Deceased Donor Kidneys: Transplant Rates by Ethnicity and Sensitization Level

  18. 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

  19. 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

  20. 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

  21. Eligible Donor Conversion RatesBy Region and Ethnicity

  22. Eligible Donor Conversion Rates, 2/1/08-11/30/11by Year: All Regions

  23. Eligible Donor Conversion Rates, 2/1/08-11/30/11by Donor Ethnicity: All Regions

  24. Eligible Donor Conversion Rates 2/1/08-11/30/11By Year and Ethnicity: All Regions

  25. 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%)

  26. 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.

  27. New Proposed Committee Projects • Survey on Referral to Heart Transplantation • Study of Best Practices in Minority Donor Conversions

  28. Special Thanks Deanna L. Parker, MPA Wida Cherikh, Ph.D

More Related