Outcome Differences across Transplant Centers

Zenios, Stefanos A.; Atias, Glenn; McCulloch, Charles E.; Petrou, Constantia

doi:10.2215/cjn.00300111

Cited by 17 publications

(14 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This method of assessing transplant center outcomes captures only one of the two important sources of data variation: random variation across patient outcomes, but not variations across transplant centers. It might also overestimate the number of centers considered to be outliers and therefore exaggerates differences between the centers with the best and worst outcomes (12). Other methods of assessing outcomes, such as generalized mixed-effects models that capture variation across transplant centers and avoid exaggerated estimates that result in classification of centers as outliers, may improve accuracy but have not been adopted in transplantation (12).…”

Section: Discussionmentioning

confidence: 99%

National Decline in Donor Heart Utilization With Regional Variability: 1995-2010

Khush

Zaroff

Nguyen

et al. 2015

American Journal of Transplantation

148

View full text Add to dashboard Cite

The severe shortage of donor hearts limits the availability of transplantation for the growing population of patients with end-stage heart disease. We examined national trends in donor heart acceptance for transplant. OPTN data were analyzed for all potential adult cardiac organ donors between 1995 and 2010. Donor heart disposition was categorized as transplanted, declined for transplant or other. We studied changes in the probability of donor heart acceptance according to demographic and clinical characteristics, nationwide and by UNOS region. Of 82 053 potential donor hearts, 34% were accepted and 48% were declined (18% used for other purposes). There was a significant decrease in donor heart acceptance from 44% in 1995 to 29% in 2006, and subsequent increase to 32% in 2010. Older donor age, female sex and medical co-morbidities predicted non-acceptance. Donor age and co-morbidities increased during the study period, with a concomitant decrease in acceptance of hearts from donors with undesirable characteristics. Overall, predictors of heart non-use were similar across UNOS regions, although utilization varied between regions. Regional variation suggests a potential to improve heart acceptance rates in under-performing regions, and supports research and policy efforts aimed at establishing evidence-based criteria for donor heart evaluation and acceptance for transplantation.

show abstract

Section: Discussionmentioning

confidence: 99%

National Decline in Donor Heart Utilization With Regional Variability: 1995-2010

Khush

Zaroff

Nguyen

et al. 2015

American Journal of Transplantation

148

View full text Add to dashboard Cite

show abstract

“…We also only used a single measure of risk-adjusted outcome at 2 years post-transplantation to define center quality on the basis of its use by regulators. However, there may be other factors beyond 1-year survival that are as important for patients (28,29).…”

Section: Discussionmentioning

confidence: 99%

Association between Kidney Transplant Center Performance and the Survival Benefit of Transplantation Versus Dialysis

Schold

Buccini²,

Goldfarb

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives Despite the benefits of kidney transplantation, the total number of transplants performed in the United States has stagnated since 2006. Transplant center quality metrics have been associated with a decline in transplant volume among low-performing centers. There are concerns that regulatory oversight may lead to risk aversion and lack of transplantation growth.Design, setting, participants, & measurements A retrospective cohort study of adults (age$18 years) wait-listed for kidney transplantation in the United States from 2003 to 2010 using the Scientific Registry of Transplant Recipients was conducted. The primary aim was to investigate whether measured center performance modifies the survival benefit of transplantation versus dialysis. Center performance was on the basis of the most recent Scientific Registry of Transplant Recipients evaluation at the time that patients were placed on the waiting list. The primary outcome was the time-dependent adjusted hazard ratio of death compared with remaining on the transplant waiting list.Results Among 223,808 waitlisted patients, 59,199 and 32,764 patients received a deceased or living donor transplant, respectively. Median follow-up from listing was 43 months (25th percentile=25 months, 75th percentile=67 months), and there were 43,951 total patient deaths. Deceased donor transplantation was independently associated with lower mortality at each center performance level compared with remaining on the waiting list; adjusted hazard ratio was 0.24 (95% confidence interval, 0.21 to 0.27) among 11,972 patients listed at high-performing centers, adjusted hazard ratio was 0.32 (95% confidence interval, 0.31 to 0.33) among 203,797 patients listed at centers performing as expected, and adjusted hazard ratio was 0.40 (95% confidence interval, 0.35 to 0.45) among 8039 patients listed at low-performing centers. The survival benefit was significantly different by center performance (P value for interaction ,0.001).Conclusions Findings indicate that measured center performance modifies the survival benefit of kidney transplantation, but the benefit of transplantation remains highly significant even at centers with low measured quality. Policies that concurrently emphasize improved center performance with access to transplantation should be prioritized to improve ESRD population outcomes.

show abstract

“…Eventually a mixed-effects model may need to be considered for more accurate estimate of program performance especially because the PSRs have serious repercussions for the center's existence. 25 It is important to recognize which adverse outcomes should be penalized. Some adverse outcomes are avoidable, but others may be unpredictable, and it may be unfair to penalize the center, for example, death from a motor vehicle accident with a functioning graft.…”

Section: Discussionmentioning

confidence: 99%