Supporting equitable access to kidney transplant in remote Western Australia using continuous quality improvement.

IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Felicity Stewart, Nicholas Corsair, James Stacey, Sarah Cox, Joshua Bowring, Khalil Patankar, Iann Lee, Kristan Teasdale, Emma Griffiths
{"title":"Supporting equitable access to kidney transplant in remote Western Australia using continuous quality improvement.","authors":"Felicity Stewart, Nicholas Corsair, James Stacey, Sarah Cox, Joshua Bowring, Khalil Patankar, Iann Lee, Kristan Teasdale, Emma Griffiths","doi":"10.1093/intqhc/mzae120","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite an epidemic of End-Stage Kidney Disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to: 1.) Design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment2.) Provide transplant suitability assessments for all patients of the service3.) Describe what temporary contraindications to kidney transplantation should be the focus of health service improvements4.) Explore participant experiences with the suitability assessment process and:5.) Use our findings to inform pre-and post-transplant model of care development within Kimberley Renal Services.</p><p><strong>Methods: </strong>Mixed methods design with file review. Transplant suitability assessment results with descriptive analysis, semi-structured interview with thematic analysis.</p><p><strong>Results: </strong>Of completed assessments, 20/66 (30%) had no contraindications and were cleared for workup with median time on dialysis prior to assessment of 2.9 years, 42/66 (64%) had temporary contraindications, and 4/66 (6%) had permanent contraindications. Eighty-five temporary contraindications were identified in 46 individuals: 17/46 had both medical and non-medical contraindications, 5/46 had medical contraindications only, and 24/46 had non-medical contraindications only. The most common temporary contraindications were smoking (23/46), treatment adherence (17/46) and high body mass index (BMI) (11/46). Patients wanted more information on the transplant process, and interviewers noted the importance of providing information in an appropriate way. Patients wanted more support to address modifiable health risk factors to improve their chances of future transplantation.</p><p><strong>Conclusions: </strong>In the first stages of our CQI approach to improving access to kidney transplants for Kimberley Aboriginal people we achieved substantial catch-up in suitability assessments, and a comprehensive summary of factors impacting successful waitlisting. Our results are consistent with, and build upon other work in this space, highlighting the importance of involving Aboriginal staff and patients in education and support for prospective recipients.</p>","PeriodicalId":13800,"journal":{"name":"International Journal for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771395/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal for Quality in Health Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/intqhc/mzae120","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Despite an epidemic of End-Stage Kidney Disease in the Australian Aboriginal and Torres Strait Islander population, disparities in access to kidney transplantation persist. The journey to successful kidney transplant is long, with an initial suitability assessment required before waitlist-specific activities begin. In an Aboriginal Community Controlled renal service, we aimed to: 1.) Design and implement a continuous quality improvement (CQI) approach to transplant suitability assessment2.) Provide transplant suitability assessments for all patients of the service3.) Describe what temporary contraindications to kidney transplantation should be the focus of health service improvements4.) Explore participant experiences with the suitability assessment process and:5.) Use our findings to inform pre-and post-transplant model of care development within Kimberley Renal Services.

Methods: Mixed methods design with file review. Transplant suitability assessment results with descriptive analysis, semi-structured interview with thematic analysis.

Results: Of completed assessments, 20/66 (30%) had no contraindications and were cleared for workup with median time on dialysis prior to assessment of 2.9 years, 42/66 (64%) had temporary contraindications, and 4/66 (6%) had permanent contraindications. Eighty-five temporary contraindications were identified in 46 individuals: 17/46 had both medical and non-medical contraindications, 5/46 had medical contraindications only, and 24/46 had non-medical contraindications only. The most common temporary contraindications were smoking (23/46), treatment adherence (17/46) and high body mass index (BMI) (11/46). Patients wanted more information on the transplant process, and interviewers noted the importance of providing information in an appropriate way. Patients wanted more support to address modifiable health risk factors to improve their chances of future transplantation.

Conclusions: In the first stages of our CQI approach to improving access to kidney transplants for Kimberley Aboriginal people we achieved substantial catch-up in suitability assessments, and a comprehensive summary of factors impacting successful waitlisting. Our results are consistent with, and build upon other work in this space, highlighting the importance of involving Aboriginal staff and patients in education and support for prospective recipients.

通过持续的质量改进,支持西澳大利亚偏远地区肾脏移植的公平获取。
背景:尽管终末期肾病在澳大利亚原住民和托雷斯海峡岛民人群中流行,但在获得肾移植方面的差异仍然存在。成功的肾脏移植之旅是漫长的,在开始特定的等待活动之前需要进行初步的适合性评估。在原住民社区控制的肾脏服务中,我们的目标是:设计并实施移植适宜性评估的持续质量改进(CQI)方法。为所有接受服务的病人提供移植适宜性评估(3)描述肾脏移植的临时禁忌症应该是卫生服务改进的重点。探索参与者的经验与适宜性评估过程和:利用我们的发现来告知金伯利肾脏服务中心移植前和移植后的护理发展模式。方法:采用混合方法设计,并进行文献回顾。移植适宜性评价结果采用描述性分析,半结构化访谈采用专题分析。结果:在完成的评估中,20/66(30%)无禁忌症,评估前透析的中位时间为2.9年,42/66(64%)有暂时禁忌症,4/66(6%)有永久性禁忌症。在46例患者中确定了85个临时禁忌症:17/46同时有医疗和非医疗禁忌症,5/46只有医疗禁忌症,24/46只有非医疗禁忌症。最常见的临时禁忌症是吸烟(23/46)、治疗依从性(17/46)和高体重指数(BMI)(11/46)。患者希望了解更多关于移植过程的信息,采访者注意到以适当方式提供信息的重要性。患者需要更多的支持来解决可改变的健康风险因素,以提高他们未来移植的机会。结论:在我们的CQI方法改善金伯利原住民获得肾脏移植的第一阶段,我们在适用性评估方面取得了实质性的进展,并对影响成功排队的因素进行了全面总结。我们的结果与这一领域的其他工作一致,并建立在其他工作的基础上,强调了让土著工作人员和患者参与教育和支持潜在接受者的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.90
自引率
3.80%
发文量
87
审稿时长
6-12 weeks
期刊介绍: The International Journal for Quality in Health Care makes activities and research related to quality and safety in health care available to a worldwide readership. The Journal publishes papers in all disciplines related to the quality and safety of health care, including health services research, health care evaluation, technology assessment, health economics, utilization review, cost containment, and nursing care research, as well as clinical research related to quality of care. This peer-reviewed journal is truly interdisciplinary and includes contributions from representatives of all health professions such as doctors, nurses, quality assurance professionals, managers, politicians, social workers, and therapists, as well as researchers from health-related backgrounds.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信