Allogeneic Transplant Physician and Center Capacity in the United States

Abstract

Shortage of manpower and center capacity is expected to be a major challenge to the anticipated future growth in the utilization of allogeneic hematopoietic-cell transplantation (HCT) in the United States (US). Using data from the National Marrow Donor Program's Transplant Center Network Renewal Survey, we describe transplant center and transplant physician capacity in the US from 2005 to 2009. Over this five year period, the number of allogeneic transplants increased by 30%, bed capacity increased by 17% and physician full time equivalents increased by 26%. The number of related donor HCT increased by 15% and unrelated donor HCT increased by 45%. In addition to large centers, small and medium sized centers also made a major contribution to overall national transplant volumes for both related and unrelated donor HCT. Increase in utilization of unrelated donor HCT occurred in centers irrespective of their size. The majority of transplant centers were performing more transplants using existing physician and bed capacity. Our study provides important description of allogeneic transplant activity and capacity of US centers and our data will assist policy makers plan for the projected growth in the use of transplantation.

Regionalization of stem cell transplant procedures into teaching hospitals in United States: are we ready?

“…These advances include availability of safer transplantation techniques, availability of alternative sources of hematopoietic stem cells, expanding indications of HCT and an increase in the overall number of patients with hematologic cancers because of an aging population. [2][3][4] The infrastructure and resources available at transplant centers can vary. As a result, centers of similar size may have different resources and personnel and vary widely in the number of transplant procedures that they perform each year.…”

“…As a result, centers of similar size may have different resources and personnel and vary widely in the number of transplant procedures that they perform each year. 4 Some of this variation is the result of center experience and local institutional forces (e.g., competition with other departments for resources and institutional commitment towards the value and services provided by the transplant program). Individual center models of delivery of care can influence the number of transplants that a center can perform efficiently.…”

Geographic access to hematopoietic cell transplantation services in the United States

“…1 Improvements in transplant outcomes because of better supportive care measures and better donor availability has allowed the use of HCT in a greater number of patients, resulting in steady increases in recent decades in the United States and worldwide; 2 each year in the United States, roughly 20 000 patients receive HCT 3 and continued growth is expected in the future. 4 Owing to the specialized nature of HCT, facilities that provide this important treatment are not commonplace in the United States (we identified 229 facilities that provide blood, marrow and/ or stem cell transplantation services in the conterminous United States, which includes the lower 48 states and Washington DC). As many of the HCT facilities are located in or near urban centers, residents living in rural regions must travel further than their urban counterparts to access these services.…”

Estimating Demand and Unmet Need for Allogeneic Hematopoietic Cell Transplantation in the United States Using Geographic Information Systems

“…2 To examine the current system and assist in developing such strategies, the National Marrow Donor Program (NMDP) sponsored HCT in 2020: A System Capacity Initiative, a multiyear initiative aiming to increase access for all patients in need of HCT by understanding and addressing personnel, systems, and infrastructural barriers to HCT. 3,4 This initiative brought together multiple stakeholders, including HCT providers (physicians, nurses, midlevel practitioners, pharmacists, and social workers), professional societies, the government, payers, and HCT program and hospital administrators to focus on the professional workforce, facility capacity and care delivery, and financial aspects of the HCT system.…”

“…Workgroups provided innovative ideas to increase HCT system efficiency using current capacity, address the needs for future capacity, and ensure adequate reimbursement of HCT programs. 2,4 One component of the System Capacity Initiative focused on assessment of the operational capacity of the US health care system to support the needs of patients undergoing HCT with respect to hospital and health care facility infrastructure and care delivery. To better inform this initiative, there was a need to describe current use of allogeneic HCT within geographic or market areas around transplant centers and assess the potential unmet need for allogeneic HCTs within those areas.…”