CT-448 Academic Center Outreach to Community Practices Increases Transplant Referrals and Possibly Reduces Racial Disparities

Abstract

Racial disparities are evident in transplant utilization rates. Outcomes improve for multiple myeloma (MM) with an autologous stem cell transplant (autoSCT) but despite the guidelines, African Americans (AA) receive fewer autoSCT when compared to whites (W). Multiple single-institution studies have confirmed that rates of autoSCT for MM in AA are similar to W when patients are referred for evaluation. Lower referral to a transplant center may contribute to these disparities. Emphasis on physician communication to facilitate an improved referral network represents an intervention to overcome this disparity. We reviewed our center data to assess the impact of outreach on transplant referrals and impact on race. We reviewed transplants (both autoSCT and alloSCT) performed at Augusta University between fiscal years 2015 to 2021. Patients were divided into two cohorts (cohort A: FY2014-17 and cohort B: FY2019-21) based on initiation of physician outreach by our program. FY2018 was used in our analysis for a year of outreach which included visiting practices within catchment area. In addition, two outreach clinics were established in collaboration with large community practice sites. Statistics are descriptive. 389 transplants analyzed included patients age >18 years with 52% males and 45% age ≥ 61 years. Cohort B had a significant increase with 266 vs 123 in cohort A, a 116% increase. There was increased median distance travelled to our center from 15.2 to 52.3 miles. Considering 15 miles as our urban area, >60% of transplants in cohort B were from outside our area. The increase in median distance travelled was found in both autoSCT and alloSCT (15.2 vs 40.3 and 15.2 vs 79.3, respectively). More significantly, cohort B had a 147% increase in AA compared to 96% in W. The distance travelled to our center was higher for W but also increased for AA at 15.4 vs 69.3 and 15.2 vs 34.8 miles, respectively. Of note, review of regional transplant center data suggests the increased volume at our center is not related to redistribution between programs across GA and SC. Our model confirms that academic outreach increases transplant referrals. The increase includes patients of minority thus may be an effective model to reduce healthcare disparities.