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

Khadijah Breathett, Ryan H. Yee, Natalie Pool, Megan C. Hebdon, Shannon M. Knapp, Elizabeth Calhoun, Nancy K. Sweitzer, Molly Carnes

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)805-814
Number of pages10
JournalAmerican Journal of Transplantation
Issue number6
StatePublished - Jun 2023
Externally publishedYes


  • health care disparities
  • heart transplantation
  • racial disparities
  • ventricular assist devices
  • women

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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