title: Lack of correlation between facility-based standardized rates of transplantation and mortality.
abstract: The standardized mortality ratio (SMR) has been used to provide information about adjusted survival outcomes at dialysis facilities. There has been concern that high rates of transplantation could unjustly lead to unfavorable SMR profiles for individual dialysis units because healthier patients would be removed from dialysis therapy, leaving less healthy patients in the dialysis pool. We correlated 1999 overall adjusted SMR and 1999 standardized transplantation ratio (STR) weighted for mortality patient count and count of first transplantations of patients younger than 65 years. A total of 2,362 facilities were included in analyses. We found no correlation between rates of transplantation (by STR) and overall mortality profile (by SMR) based on Pearson's correlation coefficients (r), either unweighted, weighted by number of patients included in the 1999 mortality calculation (SMR), or weighted by number of patients included in the 1999 transplantation calculation (r = -0.016, r = -0.015, and r = -0.015, respectively; P > 0.40 for each). Sensitivity analyses using SMR and STR over 3- and 3.5-year periods (January 1997 to June 2000) also showed no correlation between SMR and STR, respectively. We conclude that reported standardized rates for transplantation do not correlate with those reported for mortality by dialysis facilities.
authors.affiliation: Department of Internal Medicine, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Chike Nathan
authors.initials: CN
authors.lastname: Okechukwu
authors.forename: Tempie E
authors.initials: TE
authors.lastname: Hulbert-Shearon
authors.forename: Roger C
authors.initials: RC
authors.lastname: Wiggins
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolfe
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
mesh_terms: D000367:Age Factors; D000368:Aged; D000554:Ambulatory Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D006302:Health Services Research / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation / Q000401:mortality* / Q000592:standards* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D012737:Sex Factors; D014481:United States