*Purpose: Kidney transplant is the optimal treatment for end-stage kidney disease, yet only a fifth of patients are on the waitlist and inequities in access persist. The Allocation System for Changes in Equity in Kidney Transplantation (ASCENT) study tested a multicomponent intervention aimed at improving dialysis provider knowledge of the revised kidney allocation policy and waitlisting among dialysis facilities with low transplant waitlisting. The intervention included staff and patient education videos, a webinar, and transplant performance feedback report.

*Methods: To assess intervention implementation, a process evaluation guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) was conducted. RE-AIM dimensions were assessed via survey with intervention group facilities (n=334) and interviews with staff (n=6). High implementation was defined as using 3-4 intervention components and low implementation was defined as using 1-2 components.

*Results: Results revealed moderate fidelity to the intervention. Among participating facilities (n=331), 189 (57%) were high implementers, 103 (31%) were low implementers, and 39 (12%) were non-implementers. The staff education video was used most (n=213, 64%) and the webinar was used least (n=123, 37%). Dose response analysis showed higher fidelity was associated with increased provider knowledge of kidney allocation policy changes, but not increased waitlisting. Interviews revealed that intervention components were shared selectively by dialysis staff, and that the intervention helped facilities prioritize transplant education and increased staff confidence in transplant education.

*Conclusions: The findings can inform future effectiveness-implementation studies in dialysis settings aimed at improving transplant waitlisting and serve as a guide of best implementation practices for future dissemination of the ASCENT intervention.

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