title: Evaluating the Impact of Performance Improvement Initiatives on Transplant Center Reporting Compliance and Patient Follow-Up After Living Kidney Donation.
abstract: With the changing demographics of the living donor population and increased regulatory oversight, it is important that transplant centers report outcomes accurately. The aim of our retrospective cohort study of 312 living donors who underwent nephrectomy between 2008 and 2013 was to evaluate the impact of living donor program performance improvement initiatives on: (i) transplant center program reporting compliance; (ii) patient compliance with postdonation follow-up and its associated factors; and (iii) overall financial costs to the transplant center. The effect of the initiatives (donation eras 2008-2010 and 2011-2013) on compliance at key reporting points (6 months, 1 year, 2 years) was analyzed using correlation coefficients, χ(2) and Fisher's exact tests. Multivariable logistic regression models tested the initiatives' effect on the likelihood of patient follow-up. The initiatives were associated with significant improvement in form reporting compliance (r ≥ 0.862, p ≤ 0.027; 1 and 2 year Fisher's Exact p ≤ 0.002) and patient follow-up (χ(2) p ≤ 0.009) with acceptable transplant center costs. Multivariable analyses demonstrated that donation era was consistently and significantly (p < 0.001) associated with increased likelihood of postdonation patient follow-up. Institution of performance improvement initiatives with dedicated program resources is financially feasible and leads to more accurate and complete form reporting and improved patient follow-up after nephrectomy.
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: N
authors.initials: N
authors.lastname: Keshvani
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.|Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.|Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: I D
authors.initials: ID
authors.lastname: Feurer
authors.affiliation: Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: E
authors.initials: E
authors.lastname: Rumbaugh
authors.affiliation: Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: A
authors.initials: A
authors.lastname: Dreher
authors.affiliation: Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.|Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: E
authors.initials: E
authors.lastname: Zavala
authors.affiliation: Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: M
authors.initials: M
authors.lastname: Stanley
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.|Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: H M
authors.initials: HM
authors.lastname: Schaefer
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance
keywords: Clinical research/practice; donors and donation: donor follow-up; guidelines; kidney transplantation/nephrology