Liver transplant center performance profiling

2005-2011 Reports of the Scientific Registry for Transplant Recipients

Valeriya V. Kettelhut, Preethy Nayar

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Context-Transplant center performance profiling provides important information for various concerned parties. Comparing a transplant center's performance against the performance of the best-in-class centers may help in understanding the performance thresholds for the underperforming centers.Objectives-(1) To identify and describe "Centers for Medicare and Medicaid Services (CMS)-red-flag" performers and the "best-in- class" performers and (2) to examine the relationships between a center's performance profile and outcomes such as 1-year observed mortality, 1-month observed mortality, 1-year risk-Adjusted mortality, and volume.Methods-The data for analysis was obtained from the published reports on the Scientific Registry for Transplant Recipients (SRTR) website for adult liver transplant programs compiled for the rolling 2 1/2-year cohorts of patients and included 7 cohorts of liver transplant recipients in the study from January through July 1, 2002, through December 31, 2010. We defined 4 performance profiles: CMS-red-flag, lower-than-expected, higher-than-expected, and best-in-class performers.Results-The current SRTR methods classify approximately 7% of the adult liver centers as CMS-red-flag performers and 6% of the centers as best-in-class performers in every reported period. Neither of the low-volume centers (<30 liver transplants per 2 1/2-year cohort) was profiled as CMS-red-flag until the 2010 reporting period. The transplant center's profile was significantly associated with the 1-year and 1-month observed mortality rates in every reported cohort (P< .001).Conclusion-The CMS-red-flag profile can be characterized with the following: (1) the highest observed 1-year mortality, (2) the highest observed 1-month mortality, (3) a very large difference between the observed and adjusted mortality rates, and (4) the center volume greater than 30 liver transplants per 2 1/2-year cohort. The SRTR methods are not sensitive for performance profiling in the centers that perform fewer than 30 orthotopic liver transplants per 2 1/2-year cohort.

Original languageEnglish (US)
Pages (from-to)165-172
Number of pages8
JournalProgress in Transplantation
Volume23
Issue number2
DOIs
StatePublished - Jun 1 2013

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Centers for Medicare and Medicaid Services (U.S.)
Registries
Transplants
Mortality
Liver
Transplant Recipients

ASJC Scopus subject areas

  • Transplantation

Cite this

Liver transplant center performance profiling : 2005-2011 Reports of the Scientific Registry for Transplant Recipients. / Kettelhut, Valeriya V.; Nayar, Preethy.

In: Progress in Transplantation, Vol. 23, No. 2, 01.06.2013, p. 165-172.

Research output: Contribution to journalArticle

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abstract = "Context-Transplant center performance profiling provides important information for various concerned parties. Comparing a transplant center's performance against the performance of the best-in-class centers may help in understanding the performance thresholds for the underperforming centers.Objectives-(1) To identify and describe {"}Centers for Medicare and Medicaid Services (CMS)-red-flag{"} performers and the {"}best-in- class{"} performers and (2) to examine the relationships between a center's performance profile and outcomes such as 1-year observed mortality, 1-month observed mortality, 1-year risk-Adjusted mortality, and volume.Methods-The data for analysis was obtained from the published reports on the Scientific Registry for Transplant Recipients (SRTR) website for adult liver transplant programs compiled for the rolling 2 1/2-year cohorts of patients and included 7 cohorts of liver transplant recipients in the study from January through July 1, 2002, through December 31, 2010. We defined 4 performance profiles: CMS-red-flag, lower-than-expected, higher-than-expected, and best-in-class performers.Results-The current SRTR methods classify approximately 7{\%} of the adult liver centers as CMS-red-flag performers and 6{\%} of the centers as best-in-class performers in every reported period. Neither of the low-volume centers (<30 liver transplants per 2 1/2-year cohort) was profiled as CMS-red-flag until the 2010 reporting period. The transplant center's profile was significantly associated with the 1-year and 1-month observed mortality rates in every reported cohort (P< .001).Conclusion-The CMS-red-flag profile can be characterized with the following: (1) the highest observed 1-year mortality, (2) the highest observed 1-month mortality, (3) a very large difference between the observed and adjusted mortality rates, and (4) the center volume greater than 30 liver transplants per 2 1/2-year cohort. The SRTR methods are not sensitive for performance profiling in the centers that perform fewer than 30 orthotopic liver transplants per 2 1/2-year cohort.",
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