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    Financial incentives versus standard of care to improve patient compliance with live kidney donor follow-up: protocol for a multi-center, parallel-group randomized controlled trial

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    Author
    Levan, Macey L
    Waldram, Madeleine M
    DiBrito, Sandra R
    Thomas, Alvin G
    Al Ammary, Fawaz
    Ottman, Shane
    Bannon, Jaclyn
    Brennan, Daniel C
    Massie, Allan B
    Scalea, Joseph
    Barth, Rolf N
    Segev, Dorry L
    Garonzik-Wang, Jacqueline M
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    Date
    2020-11-09
    Journal
    BMC Nephrology
    Publisher
    Springer Nature
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1186/s12882-020-02117-9
    Abstract
    Background: Live kidney donors (LKDs) account for nearly a third of kidney transplants in the United States. While donor nephrectomy poses minimal post-surgical risk, LKDs face an elevated adjusted risk of developing chronic diseases such as hypertension, diabetes, and end-stage renal disease. Routine screening presents an opportunity for the early detection and management of chronic conditions. Transplant hospital reporting requirements mandate the submission of laboratory and clinical data at 6-months, 1-year, and 2-years after kidney donation, but less than 50% of hospitals are able to comply. Strategies to increase patient engagement in follow-up efforts while minimizing administrative burden are needed. We seek to evaluate the effectiveness of using small financial incentives to promote patient compliance with LKD follow-up. Methods/design: We are conducting a two-arm randomized controlled trial (RCT) of patients who undergo live donor nephrectomy at The Johns Hopkins Hospital Comprehensive Transplant Center (MDJH) and the University of Maryland Medical Center Transplant Center (MDUM). Eligible donors will be recruited in-person at their first post-surgical clinic visit or over the phone. We will use block randomization to assign LKDs to the intervention ($25 gift card at each follow-up visit) or control arm (current standard of care). Follow-up compliance will be tracked over time. The primary outcome will be complete (all components addressed) and timely (60 days before or after expected visit date), submission of LKD follow-up data at required 6-month, 1-year, and 2-year time points. The secondary outcome will be transplant hospital-level compliance with federal reporting requirements at each visit. Rates will be compared between the two arms following the intention-to-treat principle. Discussion: Small financial incentivization might increase patient compliance in the context of LKD follow-up, without placing undue administrative burden on transplant providers. The findings of this RCT will inform potential center- and national-level initiatives to provide all LKDs with small financial incentives to promote engagement with post-donation monitoring efforts. Trial registration: ClinicalTrials.gov number: NCT03090646 Date of registration: March 2, 2017 Sponsors: Johns Hopkins University, University of Maryland Medical Center Funding: The Living Legacy Foundation of Maryland © 2020, The Author(s).
    Keyword
    Care management
    Financial incentive
    Follow-up
    Kidney transplantation
    Motivation
    Organ donors
    Patient care management
    Protocol
    Quality improvement, health care
    Randomized control trial
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/14104
    ae974a485f413a2113503eed53cd6c53
    10.1186/s12882-020-02117-9
    Scopus Count
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    UMB Open Access Articles 2020

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