# Assessing the Implementation of Electronic Kidney Transplant Referral and Communication Programs

## TL;DR

This study evaluates how electronic referral programs are used to improve communication between dialysis and kidney transplant centers, finding mixed success and identifying factors that help or hinder their use.

## Contribution

The study provides new insights into the implementation of electronic transplant referral systems using a mixed-methods approach and the RE-AIM framework.

## Key findings

- 84% of staff reported using electronic transplant referral and communication programs.
- Facilitators include leadership buy-in and comprehensive training, while barriers include training costs and limited staff training.
- Programs were seen as effective but faced issues with inconsistent use by other staff.

## Abstract

Efficient communication between dialysis and kidney transplant centers is crucial to move patients through the transplant process. The implementation outcomes of electronic transplant referral and communication programs to improve this communication are unknown.

Using a convergent mixed-methods design, a process evaluation was conducted in 2023 to assess the dialysis and transplant center staff implementation of electronic transplant referral and communication programs according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework via surveys and interviews.

Overall, 101 dialysis and 30 transplant center staff completed the survey, and 84% reported using electronic transplant referral and communication programs. Respondents were 96% female, 67% social workers, and 38% had > 10 years of field experience. Respondents indicated that electronic referral programs were easy to use (70%) and effective for sending or receiving transplant referrals (80%); however, unreliable use by other staff was a barrier to using these programs (36%). Interviews (n = 13) revealed that facilitators of the programs' use are multilevel and should involve leadership buy-in and comprehensive program training. Barriers to program use included an imbalance between program training costs and gains in efficiency, programs’ benefits limited by staff implementation, and an insufficient number of staff trained to use these programs.

Electronic transplant referral and communication programs may streamline kidney transplant referrals and enhance communication; however, implementation varies between dialysis and transplant center staff. Understanding the implementation of these programs can inform interventions to refine and scale-up their use, to ultimately improve access to kidney transplant.