Development and Application of a Risk Assessment Tool for Patients Referred for Kidney Transplantation.

Abstract

Background: Racial and socioeconomic disparities exist in the rate of kidney transplant (KTx) evaluation completion among referred ESRD (end-stage renal disease) patients. A risk assessment tool was created to identify patients at high risk of not being placed on the waiting list and has been integrated as part of standard clinical process for all patient referrals at our KTx center. The purpose of the tool is to risk-stratify patients at the start of follow up in order to apply an intervention to reduce disparities in access to transplant. Methods: The risk assessment tool uses patient information to estimate probability of waitlisting in real-time for all patients referred for KTx evaluation based on clinic-level referral and national follow-up data. During the time of evaluation scheduling, patients answer questions from the risk assessment tool and are assigned a risk score. The formula for the risk score takes into account important predictors of waitlisting, including age, race, ethnicity, BMI, ESRD etiology, education level, insurance type, marital status, and primary language. These data are stored in a secure, electronic REDCap database (Figure). The use of a predictive model for access to kidney transplantation at the time of referral allows for real-time risk-stratification of patients into an intervention group.Figure: No Caption available.Results: Since initiation of the pilot study in January 2013, 1,405 patients have completed questions with the risk assessment tool. Of these patients, 451 (32%) were identified as high-risk of not waitlisting. Of the high-risk group, 78% of patients are African American, 34% have a BMI>35, 36% have a less than high school education, 93% have public insurance, 73% are single, and 9% are non-English speaking. Conclusions: The pilot study supports the effectiveness of using a risk assessment tool as part of standard clinical protocol to identify patients at high risk of not being placed on the waiting list. Use of a similar tool in other KTx centers can help providers identify patients requiring additional assistance during the KTx process in real-time to improve patient access to waitlisting.