Reported effects of the Scientific Registry of Transplant Recipients 5-tier rating system on US transplant centers: results of a national survey

Abstract

In the United States, the Scientific Registry of Transplant Recipients (SRTR) provides publicly available quality report cards. These reports have historically rated transplant programs using a 3-tier system. In 2016, the SRTR temporarily transitioned to a 5-tier system, which classified more programs as under-performing. As part of a larger survey about transplant quality metrics, we surveyed members of the American Society of Transplant Surgeons and American Society of Transplantation (N = 280 respondents) on transplant center experiences with patient and payer responses to the 5-tier SRTR ratings. Over half of respondents (n = 137, 52.1%) reported ≥1 negative effect of the new 5-tier ranking system, including losing patients, losing insurers, increased concern among patients, and increased concern among referring providers. Few respondents (n = 35, 13.7%) reported any positive effects of the 5-tier ranking system. Lower SRTR-reported scores on the 5-tier scale were associated with increased risk of reporting at least one negative effect in a logistic model (P < 0.01). The change to a more granular rating system provoked an immediate response in the transplant community that may have long-term implications for transplant hospital finances and patient options for transplantation.

Healthcare center clustering for Cox's proportional hazards model by fusion penalty

“…Due to the approximation in the computation, Equation (10) does not fully capture parameter information, and the iteration may also lead to a loss in efficiency. Once the groups have been identified, we conduct a refitting step to estimate a and 𝜷 by maximizing the following log-partial likelihood with the grouped information:…”

“…In order to offer more comprehensive ratings for kidney transplantation, the SRTR has implemented a five-tier rating system 10,11 that indicates whether a transplant center performs "better than expected", "somewhat better than expected", "as expected", "somewhat worse than expected", or "worse than expected". However, concerns arise regarding the selection of appropriate cutoffs to categorize transplant centers into distinct groups.…”

Can you hear me now? Patient preferences for evaluating kidney transplant centers

“…3,4 In this issue of the Journal, Husain et al report the results of their survey of chronic kidney disease (CKD) and kidney transplant patient attitudes surrounding the transplant-related information that they value when selecting a transplant center. 5 For both groups the waitlist was given greatest priority.…”

“…1 The main source of information available to patients and transplant providers alike comes from the Patient Specific Reports generated by the Scientific Registry of Transplant Recipients (SRTR); despite recent efforts to make this reporting more useful to patients, 2 the majority of the metrics included are directed at physicians, and patient values and preferences remain largely unexplored. 3,4 In this issue of the Journal, Husain et al report the results of their survey of chronic kidney disease (CKD) and kidney transplant patient attitudes surrounding the transplant-related information that they value when selecting a transplant center. 5 For both groups the waitlist was given greatest priority.…”