Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.
Clin Transplant. 2019 Apr;33(4):e13500. doi: 10.1111/ctr.13500. Epub 2019 Mar 6.
There is concern that the metrics currently used to regulate transplant centers, one-year patient and graft survival, may have adverse consequences including decreasing higher risk donor organ acceptance and transplant volume. This raises questions about whether alternative measures would be more appropriate.
We surveyed American Society of Transplant Surgeons (ASTS) and American Society of Transplantation (AST) members (n = 270) to characterize perceptions of several metrics that are used for regulation, are publicly reported, or have been suggested elsewhere, regarding their effectiveness, amenability to risk adjustment, and predicted effects on volume, mortality, and waitlist size.
Respondents rated one-year patient and graft survival the most effective measure of quality of care (mean scores = 7.44, 7.31, respectively, out of 10) and most amenable to risk adjustment (mean scores = 6.26, 6.13, respectively). Most respondents believed alternative metrics would not impact their center's volume, waitlist size, or one-year transplant mortality. However, some did predict unintended consequences; for example, some believed using one-year waitlist mortality, one-year mortality of patients listed, or one-year mortality of patients referred for transplant would decrease the number of transplants performed (48.6%, 46.7%, and 48.3% of respondents, respectively).
Despite previously published concerns with existing regulatory metrics, most participants did not believe any metrics would outperform one-year patient and graft survival.
目前用于监管移植中心的指标（即患者和移植物一年存活率）引起了人们的担忧，因为这些指标可能会产生一些不良后果，包括降低高风险供体器官的接受率和移植量。这引发了人们对于是否应该采用其他替代指标的质疑。
我们调查了美国移植外科学会（ASTS）和美国移植学会（AST）的成员（n=270），以了解他们对几种目前用于监管、公开报告或其他地方建议的指标的看法，包括这些指标的有效性、对风险调整的适宜性，以及对移植量、死亡率和等待名单规模的预测影响。
受访者认为患者和移植物一年存活率是评估护理质量的最有效指标（评分分别为 7.44 和 7.31），也是最适宜进行风险调整的指标（评分分别为 6.26 和 6.13）。大多数受访者认为替代指标不会影响他们中心的移植量、等待名单规模或一年移植死亡率。然而，一些受访者确实预测到了一些意料之外的后果；例如，一些人认为使用一年等待名单死亡率、列在名单上的患者一年死亡率或推荐进行移植的患者一年死亡率会降低移植数量（分别有 48.6%、46.7%和 48.3%的受访者这样认为）。
尽管之前已经发表了对现有监管指标的担忧，但大多数参与者认为没有任何指标能优于患者和移植物一年存活率。
