Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Economics, University of New Mexico, Albuquerque, NM, USA.
Transpl Int. 2018 Oct;31(10):1135-1143. doi: 10.1111/tri.13282. Epub 2018 Jun 10.
In the United States, the Scientific Registry of Transplant Recipients (SRTR) provides publicly available quality report cards. These reports have historically rated transplant programs using a 3-tier system. In 2016, the SRTR temporarily transitioned to a 5-tier system, which classified more programs as under-performing. As part of a larger survey about transplant quality metrics, we surveyed members of the American Society of Transplant Surgeons and American Society of Transplantation (N = 280 respondents) on transplant center experiences with patient and payer responses to the 5-tier SRTR ratings. Over half of respondents (n = 137, 52.1%) reported ≥1 negative effect of the new 5-tier ranking system, including losing patients, losing insurers, increased concern among patients, and increased concern among referring providers. Few respondents (n = 35, 13.7%) reported any positive effects of the 5-tier ranking system. Lower SRTR-reported scores on the 5-tier scale were associated with increased risk of reporting at least one negative effect in a logistic model (P < 0.01). The change to a more granular rating system provoked an immediate response in the transplant community that may have long-term implications for transplant hospital finances and patient options for transplantation.
在美国，移植受者科学登记处（SRTR）提供公开的质量报告卡。这些报告历史上使用三级系统对移植项目进行评级。2016 年，SRTR 暂时过渡到五级系统，将更多的项目归类为表现不佳。作为一项关于移植质量指标的更大调查的一部分，我们调查了美国移植外科医生协会和美国移植协会的成员（N=280 名受访者），了解移植中心在患者和支付方对 5 级 SRTR 评分的反应方面的经验。超过一半的受访者（n=137，52.1%）报告了新的 5 级排名系统至少有 1 个负面影响，包括失去患者、失去保险公司、患者的担忧增加，以及转诊医生的担忧增加。少数受访者（n=35，13.7%）报告了 5 级排名系统的任何积极影响。在逻辑模型中，SRTR 在 5 级量表上的评分较低与报告至少 1 个负面影响的风险增加相关（P<0.01）。更细粒度的评级系统的改变立即引发了移植界的反应，这可能对移植医院的财务和患者的移植选择产生长期影响。
