Effect of the ASCENT Intervention to Increase Knowledge of Kidney Allocation Policy Changes among Dialysis Providers
2020
Abstract Introduction The Allocation System Changes for Equity in Kidney Transplantation (ASCENT) trial was a cluster-randomized pragmatic, effectiveness-implementation study that was designed to test whether a multicomponent educational intervention targeting leadership, clinic staff, and patients in dialysis facilities improved knowledge and awareness of the 2014 kidney allocation system (KAS) change. Methods Participants included 690 dialysis-facility medical directors, nephrologists, social workers, and other staff within N=655 U.S dialysis facilities 51% (N, intervention=334) and 49% (N, control=321). Intervention activities included a webinar targeting medical directors and facility staff, a ∼10-minute educational video targeting dialysis staff, a ∼10-minute educational video targeting patients, and a facility-specific audit and feedback report of transplant performance. The control group received a standard UNOS brochure. Provider knowledge was a secondary outcome of the ASCENT trial and the primary outcome of this study; knowledge was assessed as a cumulative score on a 5-point Likert scale (higher score = greater knowledge). Intention-to-treat analysis was used. Results At baseline, non-intervention providers had higher mean knowledge score (M=2.45, SD=1.43) than intervention providers (M=2.31, SD=1.46). After 3 months, average knowledge score was slightly higher in the intervention (M=3.14, SD=1.28) vs. non-intervention providers (M=3.07, SD=1.24) and the estimated mean difference in knowledge scores between the groups at follow-up minus the mean difference at baseline was 0.25 [95%CI (0.11, 0.48), P=0.039]. The effect size (0.41) was low to moderate. Conclusions Dialysis facility provider education could help extend the impact of a national policy change in organ allocation.
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