Harkness Project Title: Cross-National Study of Racial Minorities’ Access to Renal Transplantation
Mentor: John Ayanian, M.D.
Placement: Harvard Medical School
Biography at time of Harkness Fellowship: Alan Cass, a 2002-03 Commonwealth Fund Harkness Fellow in Health Care Policy and Practice, is head of the Renal Program at the George Institute for International Health. His research program spans from global, multi-centre clinical trials generating evidence regarding the effectiveness of interventions in chronic disease, through health systems research exploring barriers to equitable health outcomes, to participatory action research aiming to improve cross-cultural competence in health care. Cass was co-organizer of a Health Policy Roundtable held in Beijing in April 2005, organized in conjunction with the Chinese Ministry of Health, to address safety and quality of health care in China. He is a lead researcher within an Indigenous Health Research Network across Australia, New Zealand and Canada, which includes four Harkness Fellows. The research collaboration aims to reduce disparities in chronic diseases and has a strong focus on research translation. Cass is the chair of the Royal Australasian College of Physicians Taskforce on Equity and Health and Inaugural chair of the Scientific Committee of the Australasian Kidney Trials Network.
Project: Cass used national datasets available in Australia, New Zealand, Canada, and the U.S. to determine disparities in access to renal transplantation for indigenous and ethnic minorities. He also interviewed key health service providers, policymakers, patients, and family members to investigate barriers to accessing renal transplantation services. He used the findings to develop strategies for reducing these barriers.
Career Activity Since Fellowship
Current Position: Director Menzies School of Health Research. (Updated 1/2014)
Gallagher M, Cass A, Bellomo R, Finfer S, Gattas D, Lee J, Lo S, McGuinness S, Myburgh J, Parke R, Rajbhandari D; POST-RENAL Study Investigators and the ANZICS Clinical Trials Group. Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial. PLoS Med. 2014 Feb 11;11(2):e1001601.
Blood Pressure Lowering Treatment Trialists' Collaboration, Ninomiya T, Perkovic V, Turnbull F, Neal B, Barzi F, Cass A, Baigent C, Chalmers J, Li N, Woodward M, MacMahon S. Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomized controlled trials. BMJ 2013 Oct 3;347:f5680.
Morrish AT, Hawley CM, Johnson DW, Badve SV, Perkovic V, Reidlinger DM, Cass A. Establishing a clinical trials network in nephrology: experience of the Australasian Kidney Trials Network. Kidney Int 2014 Jan;85(1):23-30.
Bose B, Badve SV, Hiremath SS, Boudville N, Brown FG, Cass A, de Zoysa JR, Fassett RG, Faull R, Harris DC, Hawley CM, Kanellis J, Palmer SC, Perkovic V, Pascoe EM, Rangan GK, Walker RJ, Walters G, Johnson DW. Effects of uric acid-lowering therapy on renal outcomes: a systematic review and meta-analysis. Nephrol Dial Transplant 2013 Sep 15.
Cass A, Shaw T, Ehman M, Young J, Flood J, Royce S. Improved outcomes found after implementing a systematic evaluation and program improvement process for tuberculosis. Public Health Rep 2013 Sep-Oct;128(5):367-76.
Badve SV, Beller EM, Cass A, Francis DP, Hawley C, Macdougall IC, Perkovic V, Johnson DW. Interventions for erythropoietin-resistant anaemia in dialysis patients. Cochrane Database Syst Rev 2013 Aug 26;8.
Kotwal SS, Lan P, MacLeod A, Jardine M, Snelling P, Craig J, Cass A, Gallagher M. Comparative efficacy of a team-led treatment protocol for the management of renal anaemia. Nephrology (Carlton) 2013 Oct;18(10):649-54.
Pascoe EM, Lo S, Scaria A, Badve SV, Beller EM, Cass A, Hawley CM, Johnson DW. The HONEYPOT randomized controlled trial statistical analysis plan. Perit Dial Int 2013 Jul-Aug;33(4):426-35.
Irving MJ, Tong A, Jan S, Wong G, Cass A, Allen RD, Craig JC, Chadban S, Rose J, Howard K. Community preferences for the allocation of deceased donor organs for transplantation: a focus group study. Nephrol Dial Transplant 2013 Aug;28(8):2187-93.
Hou W, Lv J, Perkovic V, Yang L, Zhao N, Jardine MJ, Cass A, Zhang H, Wang H. Effect of statin therapy on cardiovascular and renal outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. Eur Heart J 2013 Jun;34(24):1807-17.
Schneider AG, Bellomo R, Bagshaw SM, Glassford NJ, Lo S, Jun M, Cass A, Gallagher M. Choice of renal replacement therapy modality and dialysis dependence after acute kidney injury: a systematic review and meta-analysis. Intensive Care Med 2013 Jun;39(6):987-97.
Aliprandi-Costa B, Ranasinghe I, Turnbull F, Brown A, Kritharides L, Patel A, Chew D, Walters D, Rankin J, Ilton M, Meredith I, Cass A, Brieger D. The design and rationale of the Australian Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events (CONCORDANCE). Heart Lung Circ 2013 Jul;22(7):533-41.
Tonelli M, Agarwal S, Cass A, Garcia Garcia G, Jha V, Naicker S, Wang H, Yang CW, O'Donoghue D. How to advocate for the inclusion of chronic kidney disease in a national noncommunicable chronic disease program. Kidney Int 2013 Feb 13.
Knott RJ, Cass A, Heeley EL, Chalmers JP, Peiris DP, Clarke PM. How fair is Medicare? The income-related distribution of Medicare benefits with special focus on chronic care items. Med J Aust 2012 Dec 10;197(11):625-30.
Sparke C, Moon L, Green F, Mathew T, Cass A, Chadban S, Chapman J, Hoy W, McDonald S. Estimating the total incidence of kidney failure in Australia including individuals who are not treated by dialysis or transplantation. Am J Kidney Dis 2013 Mar;61(3):413-9.
Peiris D, Brown A, Howard M, Rickards BA, Tonkin A, Ring I, Hayman N, Cass A. Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment. BMC Health Serv Res 2012 Oct 28;12:369.
Jun M, Zhu B, Tonelli M, Jardine MJ, Patel A, Neal B, Liyanage T, Keech A, Cass A, Perkovic V. Effects of fibrates in kidney disease: a systematic review and meta-analysis. J Am Coll Cardiol 2012 Nov 13;60(20):2061-71.
Jun M, Jardine MJ, Gray N, Masterson R, Kerr PG, Agar JW, Hawley CM, van Eps C, Cass A, Gallagher M, Perkovic V. Outcomes of extended-hours hemodialysis performed predominantly at home. Am J Kidney Dis 2013 Feb;61(2):247-53.
Anderson K, Cunningham J, Devitt J, Preece C, Cass A. "Looking back to my family": indigenous Australian patients' experience of hemodialysis. BMC Nephrol 2012 Sep 20;13:114.
Tong A, Jan S, Wong G, Craig JC, Irving M, Chadban S, Cass A, Howard K. Rationing scarce organs for transplantation: healthcare provider perspectives on wait-listing and organ allocation. Clin Transplant 2013 Jan-Feb;27(1):60-71.
Grace BS, Clayton P, Cass A, McDonald SP. Socio-economic status and incidence of renal replacement therapy: a registry study of Australian patients. Nephrol Dial Transplant 2012 Nov;27(11):4173-80.
Grace BS, Clayton PA, Cass A, McDonald SP. Transplantation rates for living- but not deceased-donor kidneys vary with socioeconomic status in Australia. Kidney Int 2013 Jan;83(1):138-45.
Maple-Brown LJ, Hughes JT, Lawton PD, Jones GR, Ellis AG, Drabsch K, Brown AD, Cass A, Hoy WE, MacIsaac RJ, O'Dea K, Jerums G. Accurate assessment of kidney function in indigenous Australians: the estimated GFR study. Am J Kidney Dis 2012 Oct;60(4):680-2
Jamieson LM, Paradies YC, Eades S, Chong A, Maple-Brown L, Morris P, Bailie R, Cass A, Roberts-Thomson K, and Brown A. "Ten principles relevant to health research among Indigenous Australian Populations." Medical Journal of Australia. 2012; 197 (1): 16-18.
Foote C, Ninomiya T, Gallagher M, Perkovic V, Cass A, McDonald SP, Jardine M. Survival of elderly dialysis patients is predicted by both patient and practice characteristics. Nephrol Dial Transplant 2012 Sep;27(9):3581-7.
Irving MJ, Tong A, Jan S, Cass A, Chadban S, Allen RD, Craig JC, Wong G, Howard K. Community attitudes to deceased organ donation: a focus group study. Transplantation 2012 May 27;93(10):1064-9.
Anderson K, Devitt J, Cunningham J, Preece C, Jardine M, Cass A. If you can't comply with dialysis, how do you expect me to trust you with transplantation? Australian nephrologists' views on indigenous Australians' 'non-compliance' and their suitability for kidney transplantation. Int J Equity Health 2012 Apr 18;11:21.
Tong A, Jan S, Wong G, Craig JC, Irving M, Chadban S, Cass A, Marren N, Howard K. Patient preferences for the allocation of deceased donor kidneys for transplantation: a mixed methods study. BMC Nephrol 2012 Apr 18;13:18.
Wong G, Zoungas S, Lo S, Chalmers J, Cass A, Neal B, Woodward M, Perkovic V, Glasziou P, Williams B, Howard K, Chapman JR, Craig JC. The risk of cancer in people with diabetes and chronic kidney disease. Nephrol Dial Transplant 2012 Aug;27(8):3337-44.
Irving MJ, Tong A, Jan S, Cass A, Rose J, Chadban S, Allen RD, Craig JC, Wong G, Howard K. Factors that influence the decision to be an organ donor: a systematic review of the qualitative literature. Nephrol Dial Transplant 2012 Jun;27(6):2526-33.
Heeley EL, Wei JW, Carter K, Islam MS, Thrift AG, Hankey GJ, Cass A, Anderson CS. Socioeconomic disparities in stroke rates and outcome: pooled analysis of stroke incidence studies in Australia and New Zealand. Med J Aust 2011 Jul 4;195(1):10-4.
Peiris D, Usherwood T, Weeramanthri T, Cass A, Patel A. New tools for an old trade: a socio-technical appraisal of how electronic decision support is used by primary care practitioners. Sociol Health Illn 2011 Nov;33(7):1002-18.
Turnbull F, Arima H, Heeley E, Cass A, Chalmers J, Morgan C, Patel A, Peiris D, Weekes A, Anderson C. Gender disparities in the assessment and management of cardiovascular risk in primary care: the AusHEART study. Eur J Cardiovasc Prev Rehabil 2011 Jun;18(3):498-503.
Howard K, Jan S, Rose J, Chadban S, Allen RD, Irving M, Tong A, Wong G, Craig JC, Cass A. Community Preferences for the Allocation & Donation of Organs—the PAraDOx Study. BMC Public Health 2011 May 25;11:386.
Peiris D, Mohsin M, Jenkins A, Hughes C, Cass A. Robust data to close the gap: current vascular and maternal/newborn indicators as measures of progress in Aboriginal health in New South Wales. Aust N Z J Public Health 2010 Dec;34(6):563-71.
Eades SJ, Taylor B, Bailey S, Williamson AB, Craig JC, Redman S; SEARCH Investigators. The health of urban Aboriginal people: insufficient data to close the gap. Med J Aust 2010 Nov 1;193(9):521-4.
Anderson K, Yeates K, Cunningham J, Devitt J, Cass A. “They really want to go back home, they hate it here: The importance of place in Canadian health professionals’ views on the barriers facing Aboriginal patients accessing kidney transplants.” Health and Place 2009; 15(1): 390-3.
Yeates KE, Cass A, Sequist TS, McDonald SP, Jardine MJ, Trpeski L, Ayanian JZ. “Renal Indigenous people in Australia, Canada, New Zealand and the United States are less likely to receive renal transplantation.” Kidney International 2009; 76(6): 659-64
White S, McGeechan K, Jones M, Cass A, Chadban S, Polkinghorne K, Perkovic V, Roderick P. “Disadvantage and kidney disease: population-representative data from Thailand, Australia and the United States.” American Journal of Public Health 2008; 98(7): 1306-13.
White S, Chadban SJ, Jan S, Chapman J, Cass A. “How Can We Achieve Global Equity in Provision of Renal Replacement Therapy?” World Health Organisation Bulletin, 2008; 86(3): 229-37.
Cunningham J, Cass A, Anderson K, Snelling P, Devitt J, Preece C, Eris J. “Australian Nephrologists’ Attitudes Towards Living Kidney Donation,” Nephrology Dialysis Transplantation 2006; 21:1178-1183.
Cass A. “Health Outcomes in Aboriginal Populations,” Canadian Medical Association Journal 2004; 171(6):9-10.
Cass A, Cunningham J, Snelling P, Wang Z, Hoy W. “Exploring the Pathways Leading from Disadvantage to End-Stage Renal Disease for Indigenous Australians,” Social Science and Medicine 2004; 58(4):767-785.
Yeates KE, Schaubel DE, Cass A, Sequist TD, Ayanian JZ. “Access to renal transplantation for minority patients with end-stage renal disease in Canada.” American Journal of Kidney Diseases 2004; 44(6): 1083-9.
Sequist TD, Narva AS, Stiles SK, Karp SK, Cass A, Ayanian JZ. “Access to renal transplantation among American Indians and Hispanics.” American Journal of Kidney Diseases 2004; 44(2): 344-52.
Cass A, Devitt J, Preece C, Cunningham J, Anderson K, Snelling P, Eris J, Ayanian JZ. “Barriers to access by Indigenous Australians to kidney transplantation – the IMPAKT study” Nephrology 2004; 9: S144-6.
Cass A, Cunningham J, Snelling P, Wang Z, Hoy W. “Renal Transplantation for Indigenous Australians: Identifying the Barriers to Equitable Access,” Ethnicity and Health 2003; 8(2):111-119
Cass A, Cunningham J, Snelling P, Ayanian JZ. “Late referral to a nephrologist reduces access to renal transplantation.” American Journal of Kidney Diseases 2003; 42(5): 1043-9.