Background

Racial disparities persist in access to kidney transplant (KTx) in the US, where African Americans (AAs) have lower rates of waitlisting than whites. Despite the important role that dialysis facility providers can play in reducing racial disparities in KTx, little is known about their awareness of disparities. We aimed to evaluate providers' awareness of racial disparities in KTx and identify factors associated with low awareness.

Methods

We assessed awareness of disparities from questions collected in a 2016 survey of 625 dialysis facilities with low waitlisting (<15.2%, lowest US tertile) across 17 ESRD networks conducted as part of a large, dialysis facility-based clinical effectiveness study, Allocation System Changes for Equity in Kidney Transplant (ASCENT). Awareness was defined as responding “Yes” to the question “Nationally, do you think that AAs currently have lower waitlisting rates than white patients on average?” We used ASCENT data for responder and facility factors. Multivariable logistic regression models were used to identify predictors of low awareness of racial disparities.

Results

Only 19% of providers (125/642) were aware of racial disparity in KTx waitlisting: 49% of medical directors (56/113) and 10% nurse managers (32/312). In unadjusted analyses, nurse manager (vs. medical director OR:8.6,95%CI:5.1-14.5), female (vs. male OR:3.4,95%CI:2.2-5.1), and white (vs. black OR:1.9,95%CI:1.1-3.3) providers had lower awareness of racial disparity in KTx waitlisting. In analyses adjusted for provider and facility characteristics, two predictors remained significantly associated with low awareness: role and race of the provider, with nurse managers and white providers having lower awareness. Age, length of time in provider role, and number of staff and patients at facility were not significantly associated with awareness.

Conclusion

Among dialysis facilities with low waitlisting, provider awareness of racial disparities in KTx is low, particularly for nurse managers who may have more routine contact with patients. This highlights the need for interventions aimed at increasing provider awareness of disparities to improve racial disparities in KTx.

CITATION INFORMATION: Kim J, Basu M, Plantinga L, Escoffery C, Pastan S, Patzer R. Dialysis Facility Providers' Awareness of Racial Disparities in Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

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