Abstract: FR-PO874
Employing Certified Clinical Transplant Coordinators (CCTC) in Private Practice to Increase Kidney Transplant Evaluations in Pre-Dialysis Patients
Session Information
- Diversity and Equity in Kidney Health - II
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 800 Diversity and Equity in Kidney Health
Authors
- Mulhern, Jeffrey, Baystate Medical Center, Springfield, Massachusetts, United States
- Porter, Molly, Kidney Care and Transplant Services of New England, West Springfield, Massachusetts, United States
- Braden, Gregory Lee, Baystate Medical Center, Springfield, Massachusetts, United States
- Quiterio, Lili C., Kidney Care and Transplant Services of New England, West Springfield, Massachusetts, United States
- Delbuono, Joy A., Kidney Care and Transplant Services of New England, West Springfield, Massachusetts, United States
- Landry, Daniel L., Baystate Medical Center, Springfield, Massachusetts, United States
Background
Preemptive kidney transplantation, the preferred renal replacement modality for advanced CKD patients, remains underutilized due to late referral for care, competing needs of renal replacement preparation, and perhaps practice-based issues. Recent monetary incentives for successful renal transplantation allow resource allocation directed at improving rates of transplant evaluation and implantation. We report initial results of our private practice CCTC team effort to initiate and enhance transplantation discussion, referral and evaluation in our pre-dialysis patients participating in the Kidney Care First (KCF) payment model.
Methods
Practice-based CCTC were deployed on 1/1/2022 to approach all KCF patients with a GFR<25 ml/m and begin kidney transplant discussions. The CCTC-patient interactions followed a provider visit in over half the interactions. A specific referral was not required to begin the relationship, and the provider was not required to be the first to discuss renal replacement options.
Results
We compare usual care during 2021 with CCTC care during the first 4 months of 2022 in table form.
Conclusion
The deployment of a private practice CCTC team has potential benefits compared to prior usual care including a near 5-fold rise in monthly transplant center initial evaluations, a reduction in initial transplant center no-show appointments, and an improviement in the initial transplant center evaluations of Black/African American (B/AA) and Hispanic/Latino (H/L) patients. Although preemptive transplantation success will likely require approaching patients at a higher GFR, the substantial increase in initial pre-dialysis transplant center evaluations strongly supports the continuation of this ‘Transplant First’ approach to advanced CKD care.
| Year | 2021 | 2022 |
| Months | 12 | 4 |
| Non-dialysis patients in KCF | NA | 478 |
| In-office CCTC contact | NA | 120 |
| Transplant Center referrals from office | 30 | 37 |
| Transplant Center initial evaluations (%) | 23 (77) | 36 (97) |
| Transplant Center initial evaluations per month | 1.9 | 9 |
| Patient no-show (B/AA and H/L patients) | 7 (3) | 1 (1) |
| Transplant Center evaluation of B/AA and H/L patients (%) | 7 (39) | 19 (53) |
| GFR > 20 ml/m (%) | 18 | 17 |