Abstract: SA-PO083
Interdisciplinary Care Improves Transplant Evaluation Rates Prior to ESRD Among High-Risk Patients with Advanced CKD
Session Information
- Transplantation: Recipient and Donor Assessment
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Johns, Tanya S., Montefiore Medical Center, Bronx, New York, United States
- Estrella, Michelle M., University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, United States
- Boulware, L. Ebony, Duke University School of Medicine, Durham, North Carolina, United States
- Melamed, Michal L., Albert Einstein College of Medicine, Bronx, New York, United States
Background
Despite the established benefits of kidney transplantation for patients with advanced CKD, data suggest that referral to transplant nephrology is often delayed, even among patients with established nephrology care. Healthcare delivery interventions to foster transplant evaluation prior to developing ESRD are greatly needed. Interdisciplinary care (IDC), which includes nurse practitioner care coordination, is a promising intervention that may increase transplantation evaluation among patients with CKD.
Methods
We compared incident ESRD patients who received nurse practitioner care coordination as part of our IDC clinic (n= 100) to a contemporaneous cohort of incident ESRD (n= 1872) patients who received usual nephrology care alone at Montefiore Medical Center from 10/1/2013 - 10/31/2017. Montefiore Medical Center is a large tertiary institution that serves a predominately urban and poor African American and Hispanic population. All patients studied had established care with a general nephrologist and were eligible for IDC but receipt of IDC was limited by resource availability.
Results
Of the 1,972 patients included in our study, the mean age was 58 (SD 14.8), 43% were female, and 69% self-identified as African American or Hispanic. The baseline characteristics were similar between the two groups. Patients who received IDC were more likely to be evaluated by transplant nephrology prior to developing ESRD, 44% versus 24% (p < 0.001). The odds of transplant evaluation prior to developing ESRD was 3 times higher (OR 3.0 [CI 1.9- 4.6) for patients who received IDC versus usual care alone after adjusting for age, race, ethnicity, sex, and baseline comorbidities including diabetes, hypertension and cardiovascular disease. African Americans or Hispanics were less likely and younger patients were more likely to be evaluated by transplant nephrology prior to ESRD.
Conclusion
Interdisciplinary care (also known as multidisciplinary care) is associated with greater likelihood of transplant evaluation prior to ESRD compared to usual nephrology care alone in a racially and ethnically diverse population of lower SES. Larger multicenter studies are needed to determine the impact of IDC on transplant evaluation rates among patients with advanced CKD.