title: Developing Statistical Models to Assess Transplant Outcomes Using National Registries: The Process in the United States.
abstract: Created by the US National Organ Transplant Act in 1984, the Scientific Registry of Transplant Recipients (SRTR) is obligated to publicly report data on transplant program and organ procurement organization performance in the United States. These reports include risk-adjusted assessments of graft and patient survival, and programs performing worse or better than expected are identified. The SRTR currently maintains 43 risk adjustment models for assessing posttransplant patient and graft survival and, in collaboration with the SRTR Technical Advisory Committee, has developed and implemented a new systematic process for model evaluation and revision. Patient cohorts for the risk adjustment models are identified, and single-organ and multiorgan transplants are defined, then each risk adjustment model is developed following a prespecified set of steps. Model performance is assessed, the model is refit to a more recent cohort before each evaluation cycle, and then it is applied to the evaluation cohort. The field of solid organ transplantation is unique in the breadth of the standardized data that are collected. These data allow for quality assessment across all transplant providers in the United States. A standardized process of risk model development using data from national registries may enhance the field.
authors.affiliation: 1 Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.2 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.3 Institute of Health Policy, Management, and Evaluation, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada.4 Department of Medicine, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Snyder
authors.forename: Nicholas
authors.initials: N
authors.lastname: Salkowski
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Kim
authors.forename: David
authors.initials: D
authors.lastname: Zaun
authors.forename: Hui
authors.initials: H
authors.lastname: Xiong
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
mesh_terms: D000465:Algorithms; D003627:Data Interpretation, Statistical; D003661:Decision Support Techniques; D006801:Humans; D015233:Models, Statistical; D016377:Organ Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D018579:Patient Selection; D017064:Process Assessment, Health Care / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States