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Measuring Transplant Center Performance: the Goals Are Not Controversial but the Methods and Consequences Can Be

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Abstract

Purpose of Review

Risks of regulatory scrutiny has generated widespread concern about increasingly risk averse transplant center behaviors regarding both donor and candidate acceptance patterns. To address potential unintended consequences threatening access to care, we discuss recent changes in regulatory metrics and potential improvements in quality oversight of transplant centers.

Recent Findings

Despite many recent changes to 1-year patient and graft survival regulatory criteria, the capacity to accurately identify true underperforming centers and avoiding false positive flagging remains an area of great concern. Numerous studies have demonstrated restrictions in transplant volume and access following transplant center flagging.

Summary

Current regulatory criteria are limited in their capacity to accurately identify poorly performing centers and potentially encourage risk averse behavior by transplant centers. Efforts to address these concerns should focus on (1) improving risk adjustment models with better data which captures the acuity of candidate and donor risk, (2) reconsidering primary outcomes measured to assess comprehensive transplant center performance, (3) improving education to address rational or perceived disincentives, and (4) using data more effectively to share best practices.

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Papers of particular interest, published recently, have been highlighted as: •• Of major importance

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Acknowledgements

The first author, Dr. Colleen Jay, is currently supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2 TR001118.

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Authors and Affiliations

  1. University Transplant Center, University of Texas Health, San Antonio, TX, 78229, USA

    Colleen Jay

  2. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Jesse D. Schold

  3. Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Jesse D. Schold

Authors
  1. Colleen Jay
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  2. Jesse D. Schold
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Corresponding author

Correspondence to Colleen Jay.

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Conflict of Interest

Jesse Schold and Colleen Jay declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on OPTN Policy

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Jay, C., Schold, J.D. Measuring Transplant Center Performance: the Goals Are Not Controversial but the Methods and Consequences Can Be. Curr Transpl Rep 4, 52–58 (2017). https://doi.org/10.1007/s40472-017-0138-9

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  • DOI: https://doi.org/10.1007/s40472-017-0138-9

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