title: The prognostic value of kidney transplant center report cards.
abstract: SRTR report cards provide the basis for quality measurement of US transplant centers. There is limited data evaluating the prognostic value of report cards, informing whether they are predictive of prospective patient outcomes. Using national SRTR data, we simulated report cards and calculated standardized mortality ratios (SMR) for kidney transplant centers over five distinct eras. We ranked centers based on SMR and evaluated outcomes for patients transplanted the year following reports. Recipients transplanted at the 50th, 100th and 200th ranked centers had 18% (AHR = 1.18, 1.13-1.22), 38% (AHR = 1.38, 1.28-1.49) and 91% (AHR = 1.91, 1.64-2.21) increased hazard for 1-year mortality relative to recipients at the top-ranked center. Risks were attenuated but remained significant for long-term outcomes. Patients transplanted at centers meeting low-performance criteria in the prior period had 40% (AHR = 1.40, 1.22-1.68) elevated hazard for 1-year mortality in the prospective period. Centers' SMR from the report card was highly predictive (c-statistics > 0.77) for prospective center SMRs and there was significant correlation between centers' SMR from the report card period and the year following (ρ = 0.57, p < 0.001). Although results do not mitigate potential biases of report cards for measuring quality, they do indicate strong prognostic value for future outcomes. Findings also highlight that outcomes are associated with center ranking across a continuum rather than solely at performance margins.
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. scholdj@ccf.org
authors.forename: J D
authors.initials: JD
authors.lastname: Schold
authors.forename: L D
authors.initials: LD
authors.lastname: Buccini
authors.forename: E L G
authors.initials: EL
authors.lastname: Heaphy
authors.forename: D A
authors.initials: DA
authors.lastname: Goldfarb
authors.forename: A R
authors.initials: AR
authors.lastname: Sehgal
authors.forename: J
authors.initials: J
authors.lastname: Fung
authors.forename: E D
authors.initials: ED
authors.lastname: Poggio
authors.forename: M W
authors.initials: MW
authors.lastname: Kattan
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006753:Hospital Records / Q000706:statistics & numerical data*; D006801:Humans; D016030:Kidney Transplantation / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012042:Registries; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data