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Effectiveness of a culturally competent care intervention in reducing disparities in Hispanic live donor kidney transplantation: A hybrid trial
American Journal of Transplantation ( IF 8.8 ) Pub Date : 2021-09-24 , DOI: 10.1111/ajt.16857
Elisa J Gordon 1 , Jefferson J Uriarte 2 , Jungwha Lee 3 , Raymong Kang 4 , Michelle Shumate 5 , Richard Ruiz 6 , Amit K Mathur 7 , Daniela P Ladner 8 , Juan Carlos Caicedo 8
Affiliation  

Hispanic patients receive disproportionately fewer living donor kidney transplants (LDKTs) than non-Hispanic Whites (NHWs). The Northwestern Medicine Hispanic Kidney Transplant Program (HKTP), designed to increase Hispanic LDKTs, was evaluated as a nonrandomized, implementation-effectiveness hybrid trial of patients initiating transplant evaluation at two intervention and two similar control sites. Using a mixed method, observational design, we evaluated the fidelity of the HKTP implementation at the two intervention sites. We tested the impact of the HKTP intervention by evaluating the likelihood of receiving LDKT comparing pre-intervention (January 2011–December 2016) and postintervention (January 2017–March 2020), across ethnicity and centers. The HKTP study included 2063 recipients. Intervention Site A exhibited greater implementation fidelity than intervention Site B. For Hispanic recipients at Site A, the likelihood of receiving LDKTs was significantly higher at postintervention compared with pre-intervention (odds ratio [OR] = 3.17 95% confidence interval [1.04, 9.63]), but not at the paired control Site C (OR = 1.02 [0.61, 1.71]). For Hispanic recipients at Site B, the likelihood of receiving an LDKT did not differ between pre- and postintervention (OR = 0.88 [0.40, 1.94]). The LDKT rate was significantly lower for Hispanics at paired control Site D (OR = 0.45 [0.28, 0.90]). The intervention significantly improved LDKT rates for Hispanic patients at the intervention site that implemented the intervention with greater fidelity. Registration: ClinicalTrials.gov registered (retrospectively) on September 7, 2017 (NCT03276390).

中文翻译:

具有文化能力的护理干预在减少西班牙裔活体肾移植差异方面的有效性:一项混合试验

与非西班牙裔白人 (NHW) 相比,西班牙裔患者接受活体肾移植 (LDKT) 的比例要低得多。旨在增加西班牙裔 LDKT 的西北医学西班牙裔肾脏移植计划 (HKTP) 被评估为一项非随机化、实施效果混合试验,对在两个干预和两个类似控制点开始移植评估的患者进行评估。使用混合方法、观察设计,我们评估了 HKTP 在两个干预地点实施的保真度。我们通过比较不同种族和中心的干预前(2011 年 1 月至 2016 年 12 月)和干预后(2017 年 1 月至 2020 年 3 月)接受 LDKT 的可能性来测试 HKTP 干预的影响。HKTP 研究包括 2063 名受助人。干预站点 A 表现出比干预站点 B 更高的实施保真度。对于站点 A 的西班牙裔接受者,与干预前相比,干预后接受 LDKT 的可能性显着更高(优势比 [OR] = 3.17 95% 置信区间 [1.04, 9.63 ]), 但不在配对控制站点 C (OR = 1.02 [0.61, 1.71])。对于站点 B 的西班牙裔接受者,接受 LDKT 的可能性在干预前后没有差异 (OR = 0.88 [0.40, 1.94])。配对对照站点 D 的西班牙裔美国人的 LDKT 率明显较低(OR = 0.45 [0.28, 0.90])。该干预显着提高了以更高保真度实施干预的干预地点西班牙裔患者的 LDKT 率。注册:ClinicalTrials.gov 于 9 月 7 日(追溯)注册,
更新日期:2021-09-24
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