Facility profiling under competing risks using multivariate prognostic scores: Application to kidneytransplant centers

Abstract

The performance of health care facilities (e.g. hospitals, transplant centers, etc.) is often evaluated through time-to-event outcomes. In this paper, we consider the case where, for each subject, the failure event is due to one of several mutually exclusive causes (competing risks). Since the distribution of patient characteristics may differ greatly by the center, some form of covariate adjustment is generally necessary in order for center-specific outcomes to be accurately compared (to each other or to an overall average). We propose a weighting method for comparing facility-specific cumulative incidence functions to an overall average. The method directly standardizes each facility’s non-parametric cumulative incidence function through a weight function constructed from a multivariate prognostic score. We formally define the center effects and derive large-sample properties of the proposed estimator. We evaluate the finite sample performance of the estimator through simulation. The proposed method is applied to the end-stage renal disease setting to evaluate the center-specific pre-transplant mortality and transplant cumulative incidence functions from the Scientific Registry of Transplant Recipients.

Prognostic score‐based methods for estimating center effects based on survival probability: Application to post‐kidney transplant survival

“…As detailed in Sections 2 and 3, we adapt prognostic score class weighting 28 into survival outcomes in an attempt to capitalize on the benefits of matching, scoring and semi-parametric modeling, while addressing the limitations of such approaches. Essentially, a center-stratified semi-parametric hazard model is fitted, with the linear predictor serving as the basis of a prognostic score 29,30 which indexes each patient's death risk, independent of center (via the stratification).…”