Evaluating Spatial Associations in Inpatient Deaths Between Organ Procurement Organizations
To improve the measurement of organ procurement organization (OPO) performance, the Center for Medicare and Medicaid Services recently proposed using inpatient deaths defined as the eligible pool of organ donors within an OPO as patients 75 years or younger that died from any cause that would not pr...
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Published in | Transplantation direct Vol. 7; no. 3; p. e668 |
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Main Authors | , |
Format | Journal Article |
Language | English |
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United States
Lippincott Williams & Wilkins
01.03.2021
Wolters Kluwer |
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Abstract | To improve the measurement of organ procurement organization (OPO) performance, the Center for Medicare and Medicaid Services recently proposed using inpatient deaths defined as the eligible pool of organ donors within an OPO as patients 75 years or younger that died from any cause that would not preclude donation.
To account for the geographic variation in OPO performance and organ availability across the United States, we utilized spatial analysis to appraise the newly proposed metric of inpatient deaths.
Using spatial clustering that accounts for geographic relationships between Organ Procurement Organizations, the top 5 causes of donation-eligible death, and inpatient deaths, we identified 4 unique OPO clusters. Each group had a distinct demographic composition, cause of death, and inpatient death pattern. In multivariate analysis accounting for these geographic relationships, the spatial clusters remained significantly associated with the outcome of inpatient deaths (
< 0.001) and were the best-fitting model compared with models without the spatial clusters; this suggests that further risk adjustment of inpatient deaths should include these geographic considerations.
This approach provides not only a manner to assess donor potential by improving risk adjustment but also an opportunity to further explore geographic and spatial relationships in the practice of organ transplantation and OPO performance. |
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AbstractList | Background. To improve the measurement of organ procurement organization (OPO) performance, the Center for Medicare and Medicaid Services recently proposed using inpatient deaths defined as the eligible pool of organ donors within an OPO as patients 75 years or younger that died from any cause that would not preclude donation. Methods. To account for the geographic variation in OPO performance and organ availability across the United States, we utilized spatial analysis to appraise the newly proposed metric of inpatient deaths. Results. Using spatial clustering that accounts for geographic relationships between Organ Procurement Organizations, the top 5 causes of donation-eligible death, and inpatient deaths, we identified 4 unique OPO clusters. Each group had a distinct demographic composition, cause of death, and inpatient death pattern. In multivariate analysis accounting for these geographic relationships, the spatial clusters remained significantly associated with the outcome of inpatient deaths ( P < 0.001) and were the best-fitting model compared with models without the spatial clusters; this suggests that further risk adjustment of inpatient deaths should include these geographic considerations. Conclusions. This approach provides not only a manner to assess donor potential by improving risk adjustment but also an opportunity to further explore geographic and spatial relationships in the practice of organ transplantation and OPO performance. Supplemental Digital Content is available in the text. To improve the measurement of organ procurement organization (OPO) performance, the Center for Medicare and Medicaid Services recently proposed using inpatient deaths defined as the eligible pool of organ donors within an OPO as patients 75 years or younger that died from any cause that would not preclude donation. To improve the measurement of organ procurement organization (OPO) performance, the Center for Medicare and Medicaid Services recently proposed using inpatient deaths defined as the eligible pool of organ donors within an OPO as patients 75 years or younger that died from any cause that would not preclude donation. To account for the geographic variation in OPO performance and organ availability across the United States, we utilized spatial analysis to appraise the newly proposed metric of inpatient deaths. Using spatial clustering that accounts for geographic relationships between Organ Procurement Organizations, the top 5 causes of donation-eligible death, and inpatient deaths, we identified 4 unique OPO clusters. Each group had a distinct demographic composition, cause of death, and inpatient death pattern. In multivariate analysis accounting for these geographic relationships, the spatial clusters remained significantly associated with the outcome of inpatient deaths ( < 0.001) and were the best-fitting model compared with models without the spatial clusters; this suggests that further risk adjustment of inpatient deaths should include these geographic considerations. This approach provides not only a manner to assess donor potential by improving risk adjustment but also an opportunity to further explore geographic and spatial relationships in the practice of organ transplantation and OPO performance. To improve the measurement of organ procurement organization (OPO) performance, the Center for Medicare and Medicaid Services recently proposed using inpatient deaths defined as the eligible pool of organ donors within an OPO as patients 75 years or younger that died from any cause that would not preclude donation.METHODSTo account for the geographic variation in OPO performance and organ availability across the United States, we utilized spatial analysis to appraise the newly proposed metric of inpatient deaths.RESULTSUsing spatial clustering that accounts for geographic relationships between Organ Procurement Organizations, the top 5 causes of donation-eligible death, and inpatient deaths, we identified 4 unique OPO clusters. Each group had a distinct demographic composition, cause of death, and inpatient death pattern. In multivariate analysis accounting for these geographic relationships, the spatial clusters remained significantly associated with the outcome of inpatient deaths (P < 0.001) and were the best-fitting model compared with models without the spatial clusters; this suggests that further risk adjustment of inpatient deaths should include these geographic considerations.CONCLUSIONSThis approach provides not only a manner to assess donor potential by improving risk adjustment but also an opportunity to further explore geographic and spatial relationships in the practice of organ transplantation and OPO performance. |
Author | Dey, Tanujit Adler, Joel T |
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Snippet | To improve the measurement of organ procurement organization (OPO) performance, the Center for Medicare and Medicaid Services recently proposed using inpatient... Background. To improve the measurement of organ procurement organization (OPO) performance, the Center for Medicare and Medicaid Services recently proposed... Supplemental Digital Content is available in the text. To improve the measurement of organ procurement organization (OPO) performance, the Center for Medicare... |
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Title | Evaluating Spatial Associations in Inpatient Deaths Between Organ Procurement Organizations |
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