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Abstract: FR-PO876

Impact of the ESRD Treatment Choices (ETC) Model on Kidney Transplant Waitlisting by Race and Ethnicity

Session Information

Category: Diversity and Equity in Kidney Health

  • 800 Diversity and Equity in Kidney Health

Authors

  • Potluri, Vishnu S., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Peng, Chen, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Reddy, Yuvaram N.V., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Tummalapalli, Sri Lekha, Weill Cornell Medicine, New York, New York, United States
  • Huang, Qian, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Liao, Joshua, University of Washington, Seattle, Washington, United States
  • Navathe, Amol, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Background

The ESRD Treatment Choices (ETC) Model - implemented in January 2021 - randomized dialysis providers and nephrologists in 30% of US hospital referral regions to receive financial incentives based on rates of home dialysis and access to transplantation. The model also included a health equity incentive to reduce disparities among dually eligible Medicare and Medicaid patients, who are low socioeconomic status and disproportionately Black and Hispanic. In this study, we used data from the US transplant registry to describe the early impact of the model on transplant waitlisting.

Methods

We assembled a cohort of adult Medicare beneficiaries on dialysis who were waitlisted for a kidney transplant between Jan 1, 2017 and Sept 30, 2021. The cohort was divided into the intervention and control arms of the ETC model. Kidney transplant waitlisting between groups was evaluated using an interrupted time series design. We used piecewise linear regression to compare slope changes in waitlist additions between the intervention and control arms for the overall population, Black, and Hispanic transplant candidates.

Results

Following implementation of the ETC model, there were 4975 waitlist additions in the intervention arm and 8438 additions in the control arm. Post-ETC model, we found no significant difference in kidney transplant waitlist additions between the intervention and control arm for the overall cohort (Figure 1 slope difference 0.87/month p-value 0.068), Black (slope difference 0.25/month, p-value 0.23), and Hispanic transplant candidates (slope difference 0.04/month, p-value 0.75).

Conclusion

In the first 9-months following implementation of the ETC model, we did not detect an increase in new kidney transplant waitlist additions overall or among racial and ethnic minorities. Longer-term follow-up is required to determine if the ETC model incentives are sufficient to overcome barriers to transplant waitlisting.

Funding

  • NIDDK Support