Abstract: FR-PO1040
Barriers to Kidney Transplantation in the Largest Safety Net Hospital in New York: A Quality Improvement Project
Session Information
- Social, Environmental, and Economic Determinants of Kidney Health
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Basa, Adrianne Franche, NYU Langone Health, New York, New York, United States
- Ali, Nicole, NYU Langone Health, New York, New York, United States
- Layman, Robin G., NYU Langone Health, New York, New York, United States
- Caplin, Nina J., NYU Langone Health, New York, New York, United States
Background
Kidney transplant (KT) is the preferred treatment for patients with ESKD because of increased survival and improved quality of life. However, there is a lower rate of transplant among underserved patients. Bellevue Hospital Center (BHC) is a safety net hospital and serves primarily a disadvantaged population. It was observed that a minority of BHC patients receiving dialysis or CKD5 had been referred for transplant evaluation. The goal of this QI project is to assess if a new approach to systematic and coordinated referral would help rectify the disparity in this population and identify the obstacles BHC patients experience.
Methods
The renal staff identified admitted patients who might qualify for transplantation. The patients' names were sent to the NYU transplant coordinator. We interviewed patients to discuss obstacles to scheduling appointments, completing screening, and receiving a transplant. A chart review correlated referral patterns with dialysis unit (DU) CMS ratings, location and patients’ home address. We conducted a zoom lecture for interested patients to reinforce the benefits of KT.
Results
From March 2023 to September 2023, 38 patients were referred for KT evaluation. 53% scheduled an appointment with a transplant center. 47% were interviewed.
INTERVIEWED PATIENTS
55% of patients live in Brooklyn, 27% in Manhattan, 16% in the Bronx, and 5% in Queens. 58% of the DU are located in a zip code with median household income of less than $60,000. The average CMS rating of the dialysis units is 3.5. 72% had called and received an appointment within a month. 3 completed evaluation and one was transplanted; 61% are still undergoing evaluation. Reasons patients had for not calling: uncertain how to proceed, forgot to call or forgot about the referral. 44% wanted to join a virtual class to learn about KT. 2 patients attended the virtual class.
Conclusion
There is a disparity in the rates of referral to transplant centers among underserved patients. To address this disparity at BHC, we created a coordinated referral system with our affiliated transplant center. We also identified some barriers that impede the completion of this cumbersome process. Facilitating the process of kidney transplant evaluation and providing more support would benefit our underserved population and enable more access to this superior treatment option.