title: Liver transplant center performance profiling: 2005-2011 reports of the Scientific Registry for Transplant Recipients.
abstract: CONTEXT-Transplant center performance profiling provides important information for various concerned parties. Comparing a transplant center's performance against the performance of the best-in-class centers may help in understanding the performance thresholds for the underperforming centers. OBJECTIVES-(1) To identify and describe "Centers for Medicare and Medicaid Services (CMS)-red-flag" performers and the "best-in-class" performers and (2) to examine the relationships between a center's performance profile and outcomes such as 1-year observed mortality, 1-month observed mortality, 1-year risk-adjusted mortality, and volume. METHODS-The data for analysis was obtained from the published reports on the Scientific Registry for Transplant Recipients (SRTR) website for adult liver transplant programs compiled for the rolling 2 1/2-year cohorts of patients and included 7 cohorts of liver transplant recipients in the study from January through July 1, 2002, through December 31, 2010. We defined 4 performance profiles: CMS-red-flag, lower-than-expected, higher-than-expected, and best-in-class performers. RESULTS-The current SRTR methods classify approximately 7% of the adult liver centers as CMS-red-flag performers and 6% of the centers as best-in-class performers in every reported period. Neither of the low-volume centers (<30 liver transplants per 2 1/2-year cohort) was profiled as CMS-red-flag until the 2010 reporting period. The transplant center's profile was significantly associated with the 1-year and 1-month observed mortality rates in every reported cohort (P< .001). CONCLUSION-The CMS-red-flag profile can be characterized with the following: (1) the highest observed 1-year mortality, (2) the highest observed 1-month mortality, (3) a very large difference between the observed and adjusted mortality rates, and (4) the center volume greater than 30 liver transplants per 2 1/2-year cohort. The SRTR methods are not sensitive for performance profiling in the centers that perform fewer than 30 orthotopic liver transplants per 2 1/2-year cohort.
authors.affiliation: University of Nebraska Medical Center, Omaha, NE 68198, USA. vkettelhut@nebraskamed.com
authors.forename: Valeriya V
authors.initials: VV
authors.lastname: Kettelhut
authors.forename: Preethy
authors.initials: P
authors.lastname: Nayar
mesh_terms: D000704:Analysis of Variance; D014487:Centers for Medicare and Medicaid Services, U.S.; D015331:Cohort Studies; D006782:Hospitals, Special / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality* / Q000592:standards / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D012042:Registries / Q000706:statistics & numerical data*; D014481:United States