Barriers and facilitators to developing an equity dashboard to identify disparities in kidney transplant access: a mixed methods study

Abstract

Introduction While kidney transplant disparities are well-documented, little is known about disparities in the evaluation process after referral. Electronic dashboards interfacing with electronic health records can disaggregate patient data to identify potential avenues for reducing disparities. This cross-sectional study assessed contextual and design factors that would inform implementation of an ‘Equity Dashboard’ at one transplant center. Methods Clinicians, implementation science experts, and patients were interviewed. Qualitative data were analyzed using thematic analysis guided by the Consolidated Framework for Implementation Research. Quantitative data comprised primarily descriptive survey data collected during interviews. Results Twenty clinicians/experts and 23 patients participated. Perceived facilitators included: Inner Setting constructs of mission alignment, culture, tension for change, compatibility, and structural characteristics; and Individual Characteristics construct of high-level leaders. Dashboard alignment was expected with institutional commitment to patient-centered care, center workflow, and leadership support. Perceived barriers included: Intervention Characteristics construct of costs; and Inner Setting constructs of access to knowledge and information, information technology infrastructure, and work infrastructure. Financial costs were expected to support information technology development, staff training and time, and interventions arising from dashboard findings. Conclusions Our findings suggest that perceived barriers were largely modifiable while perceived facilitators were immutable and integral to the institution, which would facilitate dashboard implementation. Future research will evaluate dashboard implementation on patients’ transplant access.