New Tools and a Population-Based Approach to Improve Kidney Transplant Opportunity and Preemptive Waitlisting

Area of Science:

• Nephrology
• Transplantation Medicine
• Health Informatics

Background:

• Kidney transplantation offers improved survival and quality of life but faces access barriers.
• Provider discussions and timely referrals are crucial for enhancing kidney transplant access.
• Standardizing documentation and tracking care can reduce referral variability and address barriers.

Purpose of the Study:

• To assess the impact of a novel electronic health record (EHR) tool on improving kidney transplant referrals.
• To evaluate the effect of standardized documentation on the kidney transplant continuum.
• To analyze changes in patient characteristics within the transplant pathway.

Main Methods:

• A population-based approach identified advanced chronic kidney disease (CKD) patients within an integrated health system.
• A system-wide EHR tool was implemented to mandate documentation of transplant discussions.
• Patient data were evaluated over five years to track the kidney transplant continuum and patient demographics.

Main Results:

• The EHR tool achieved 100% documentation of transplant discussions within months.
• The number of patients in the transplant continuum nearly doubled (from 554 to 974) over five years.
• Patients added post-intervention were older and more likely to be Black; 65% of waitlisted patients were referred before dialysis.

Conclusions:

• A simple EHR tool can sustainably increase transplant option discussion documentation.
• The intervention effectively expanded the waitlist and transplant opportunities.
• This approach demonstrates a scalable method to improve kidney transplant access.