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

• Published in: American journal of transplantation Vol. 23; no. 6; pp. 805 - 814
• Main Authors: Breathett, Khadijah, Yee, Ryan H., Pool, Natalie, Hebdon, Megan C., Knapp, Shannon M., Calhoun, Elizabeth, Sweitzer, Nancy K., Carnes, Molly
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2023
• Subjects: health care disparities; Heart Failure - therapy; heart transplantation; Humans; racial disparities; Surveys and Questionnaires; ventricular assist devices; women; racial disparities; ventricular assist devices; DCRDP; heart transplantation; SOCIAL HF; health care disparities; ARMS; LVAD; COVID-19; AHF therapies; RE; COM-B/BCW; Opportunity; SIPAT; women; AHF
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1016/j.ajt.2023.03.005

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.