Pilot test of a multicomponent implementation strategy for equity in advanced heart failure allocation

Area of Science:

• Cardiology
• Healthcare Management
• Health Equity

Background:

• Advanced heart failure (AHF) therapy allocation faces challenges due to subjective assessments and suboptimal group dynamics, potentially leading to bias.
• Ensuring equitable distribution of scarce AHF resources is critical for patient outcomes and ethical healthcare delivery.

Purpose of the Study:

• To assess the feasibility of an implementation strategy aimed at fostering organizational and cultural change to support equity in AHF therapy allocation.
• To determine if a multicomponent intervention could mitigate bias and improve group dynamics within AHF decision-making teams.

Main Methods:

• A pretest-posttest design was employed at an AHF center, incorporating an 8-week training program focused on bias reduction, standardized social assessments, and improved group dynamics.
• Evaluations included pre/post surveys of AHF team members, meeting transcript analysis using a standardized scoring system for group dynamics, and posttest interviews.
• Data were analyzed using qualitative descriptive methods and Brunner-Munzel tests to calculate relative effect (RE), with RE >0.5 indicating posttest improvement.

Main Results:

• The majority of survey metrics indicated potential benefits, with a relative effect (RE) greater than 0.5.
• Five out of six assessed group dynamics metrics showed improvement (RE >0.5).
• Key implementation themes included promoting equitable resource distribution, adjusting team member time investment and meeting structures, and adapting the process for broader application.

Conclusions:

• The proposed implementation strategy is feasible for driving organizational and cultural changes necessary for equitable AHF therapy allocation.
• The intervention demonstrated potential to reduce bias and enhance group dynamics, contributing to a more just allocation process.
• The strategy's adaptability suggests its potential application beyond AHF and reinforces the importance of ongoing training.