Getz Kelly D, He Christy, Li Yimei, Huang Yuan-Shung V, Burstein Danielle S, Rossano Joseph, Aplenc Richard
Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Drexel University College of Medicine, Philadelphia, PA, USA.
Pediatr Transplant. 2018 Aug;22(5):e13168. doi: 10.1111/petr.13168. Epub 2018 Apr 10.
Data routinely collected through United Network for Organ Sharing (UNOS) lack the detailed information on medical resource utilization and treatment costs required to accomplish for center-level comparisons of quality of care and cost for pediatric heart transplantation. We aimed to overcome this limitation by merging UNOS with the Pediatric Health Information System (PHIS) database, an administrative database containing inpatient, emergency department, ambulatory surgery, and observation unit information from over 40 not-for-profit, tertiary care pediatric hospitals. Utilizing a probabilistic match based on center, date of birth, recipient gender, and transplant date within ±2 days, more than 90% of eligible UNOS patients (N = 2264) were successfully merged to their corresponding PHIS records. Thirty-day and 1-year mortality rates observed for the merged cohort (3.2% and 9.0%, respectively) were compared with those previously reported for pediatric heart transplants, as were the significant predictors of increased mortality. These results demonstrate that the established UNOS-PHIS cohort will provide a valid platform for subsequent research aimed at identifying center-level differences that could be exploited to optimize quality of care while minimizing cost across institutions.
通过器官共享联合网络(UNOS)常规收集的数据缺乏进行儿科心脏移植护理质量和成本的中心层面比较所需的医疗资源利用和治疗成本的详细信息。我们旨在通过将UNOS与儿科健康信息系统(PHIS)数据库合并来克服这一限制,PHIS数据库是一个行政数据库,包含来自40多家非营利性三级护理儿科医院的住院、急诊科、门诊手术和观察单元信息。利用基于中心、出生日期、受者性别和移植日期在±2天内的概率匹配,超过90%符合条件的UNOS患者(N = 2264)成功与其相应的PHIS记录合并。将合并队列观察到的30天和1年死亡率(分别为3.2%和9.0%)与先前报道的儿科心脏移植死亡率进行比较,同时比较死亡率增加的显著预测因素。这些结果表明,已建立的UNOS-PHIS队列将为后续研究提供一个有效的平台,旨在识别中心层面的差异,这些差异可用于优化护理质量,同时在各机构间将成本降至最低。