Effect of the ASCENT Intervention to Increase Knowledge of Kidney Allocation Policy Changes among Dialysis Providers

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.