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

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

Authors :
Breathett K
Yee RH
Pool N
Hebdon MC
Knapp SM
Calhoun E
Sweitzer NK
Carnes M
Source :
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2023 Jun; Vol. 23 (6), pp. 805-814. Date of Electronic Publication: 2023 Mar 15.
Publication Year :
2023

Abstract

Advanced heart failure (AHF) therapy allocation is vulnerable to bias related to subjective assessments and poor group dynamics. Our objective was to determine whether an implementation strategy for AHF team members could feasibly contribute to organizational and culture change supporting equity in AHF allocation. Using a pretest-posttest design, the strategy included an 8-week multicomponent training on bias reduction, standardized numerical social assessments, and enhanced group dynamics at an AHF center. Evaluations of organizational and cultural changes included pretest-posttest AHF team member surveys, transcripts of AHF meetings to assess group dynamics using a standardized scoring system, and posttest interviews guided by a framework for implementing a complex strategy. Results were analyzed with qualitative descriptive methods and Brunner-Munzel tests for relative effect (RE, RE >0.5 signals posttest improvement). The majority of survey metrics revealed potential benefit with RE >0.5. REs were >0.5 for 5 of 6 group dynamics metrics. Themes for implementation included (1) promoting equitable distribution of scarce resources, (2) requiring a change in team members' time investment to correct bias and change the meeting structure, (3) slowing and then accelerating the allocation process, and (4) adaptable beyond AHF and reinforceable with semi-annual trainings. An implementation strategy for AHF equity demonstrated the feasibility for organizational and culture changes.<br /> (Copyright © 2023 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1600-6143
Volume :
23
Issue :
6
Database :
MEDLINE
Journal :
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Publication Type :
Academic Journal
Accession number :
36931436
Full Text :
https://doi.org/10.1016/j.ajt.2023.03.005