title: Association of transplant center and physician factors on mortality after hematopoietic stem cell transplantation in the United States.
abstract: The effect of the organization and delivery of health care at medical centers, referred to as "center effects," with clinical outcomes after hematopoietic stem cell transplantation (HSCT) is not clear. We examined the association between center and treatment provider factors and mortality after HSCT. We surveyed 163 (87% response rate) United States transplantation centers that performed HLA-identical sibling HSCT for leukemia or autologous HSCT for lymphoma between 1998 and 2000 among patients at least 18 years old. One hundred thirteen (69%) centers performed HLA-identical sibling transplantations, whereas 162 (99%) performed autologous transplantations. Factors associated with decreased 100-day mortality in the allogeneic setting include a higher patient-per-physician ratio (P = .003) and centers where physicians answer calls after office hours (P = .03). Medical school affiliation was not associated with increased 100-day mortality except in centers where students/residents are present without fellows (P = .02). Center effects were weaker in autologous HSCT at 1 year. Differences in 100-day mortality in patients receiving transplants in centers with favorable versus unfavorable factors were greater in allogeneic than autologous HSCT. Greater physician involvement in patient care is important in producing favorable outcomes after HSCT. To more clearly establish the role of the factors we identified, further studies are recommended.
authors.affiliation: University of Nebraska Medical Center, Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA. FLOBERIZA@unmc.edu
authors.forename: Fausto R
authors.initials: FR
authors.lastname: Loberiza
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.forename: Charles F
authors.initials: CF
authors.lastname: LeMaistre
authors.forename: Derek S
authors.initials: DS
authors.lastname: Serna
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Bredeson
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Rizzo
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D013502:General Surgery / Q000706:statistics & numerical data*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D007938:Leukemia / Q000401:mortality* / Q000628:therapy; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology