Effect of a Multi-Component Intervention to Improve Patient Access to Kidney Transplantation and Living Kidney Donation
Bibliographic record
Abstract
Background: Patients with advanced chronic kidney disease (CKD) have the best chance for a longer and healthier life if they receive a kidney transplant. However, many barriers prevent patients from receiving a transplant. Methods: We conducted a pragmatic, two-arm, parallel-group, cluster-randomized trial of a multi-component intervention designed to target several barriers which prevent kidney transplantation and living donation. The trial included all 26 CKD programs in Ontario, Canada, from Nov 2017 to Dec 2021. These programs care for patients with advanced CKD (patients approaching the need for dialysis or receiving maintenance dialysis). Using covariate-constrained randomization, we allocated the CKD programs (1:1) to provide the intervention or usual care for 4.2 years. The intervention had 4 main components: (1) administrative support to establish local quality improvement teams; (2) transplant educational resources; (3) an initiative for transplant recipients and living donors to share stories and experiences; and (4) program-level performance reports and oversight by administrative leaders. The primary outcome was a composite of all completed steps toward receiving a kidney transplant. Each patient could complete up to 4 steps: step 1, referred to a transplant center for evaluation; step 2, had a potential living donor contact a transplant center for evaluation; step 3, added to the deceased donor waitlist; and step 4, received a transplant from a living or deceased donor. Results: The 26 CKD programs (13 intervention, 13 usual care) during the trial period cared for 20 375 potentially transplant-eligible patients with advanced CKD (intervention [n=9780 patients], usual care [n=10 595 patients]). Despite evidence of intervention uptake, the step completion rate did not significantly differ between the intervention versus usual-care groups: 5334 vs. 5638 steps; 24.8 vs. 24.1 steps per 100 patient-years; adjusted hazard ratio 1.00 (95% CI, 0.87-1.15). Results were consistent in multiple analyses. Conclusions: This province-wide strategy did not increase the rate of completed steps toward receiving a kidney transplant. Improving access to transplantation remains a global priority. Future efforts can build on lessons learned. Protocol: PMID 33948191 Protocol, Process evaluation: PMID 35340770 Statistical analytic plan: PMID 36438439 ClinicalTrials.gov record: NCT03329521 Funding: Commercial Support - Partnership grant funding received from Astellas Canada, Government Support - Non-U.S.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.010 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".