The Association of Center Performance Evaluations and Kidney Transplant Volume in the United States

• Published in: American journal of transplantation Vol. 13; no. 1; pp. 67 - 75
• Main Authors: Schold, J. D., Buccini, L. D., Srinivas, T. R., Srinivas, R. T., Poggio, E. D., Flechner, S. M., Soria, C., Segev, D. L., Fung, J., Goldfarb, D. A.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley 01.01.2013; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Blood & organ donations; Center effects; Female; Humans; kidney transplantation; Kidney Transplantation - statistics & numerical data; Male; Medical sciences; Middle Aged; Miscellaneous; Public health. Hygiene; Public health. Hygiene-occupational medicine; quality of care; report cards; risk adjustment; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Transplants & implants; United States; United States; North America; America; Performance evaluation; Center; Adjustment; Report; Risk; risk adjustment; Center effects; Homotransplantation; quality of care; Kidney; Care; Card; report cards; Association; Treatment; Urinary system; Volume; Surgery; Quality; Risk factor; Graft; Public health; Kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2012.04345.x

Report cards evaluating transplant center performance have received significant attention in recent years corresponding with the Centers for Medicare and Medicaid Services issue of the 2007 Conditions of Participation. Our primary aim was to evaluate the association of report card evaluations with transplant center volume. We utilized data from the Scientific Registry of Transplant Recipients (SRTR) along with six consecutive program‐specific reports from January 2007 to July 2009 for adult kidney transplant centers. Among 203 centers, 46 (23%) were low performing (LP) with statistically significantly lower than expected 1‐year graft or patient survival at least once during the study period. Among LP centers, there was a mean decline in transplant volume of 22.4 cases compared to a mean increase of 7.8 transplants among other centers (p = 0.001). Changes in volume between LP and other centers were significant for living, standard and expanded criteria deceased donor (ECD) transplants. LPs had a reduction in use of donors with extended cold ischemia time (p = 0.04) and private pay recipients (p = 0.03). Centers without low performance evaluations were more likely to increase the proportion of overall transplants that were ECDs relative to other centers (p = 0.04). Findings indicate a significant association between reduced kidney transplant volume and low performance report card evaluations. There is a significant association between low performance evaluations of transplant centers in programspecific reports and a decline in kidney transplant volume. See also editorial by Axelrod on page 7 and personal viewpoint by Schnier et al on page 31.