Division of Digestive Health and Liver Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Transplant. 2020 Sep;20(9):2337-2342. doi: 10.1111/ajt.15865. Epub 2020 Apr 9.
In December of 2019, the Centers for Medicare and Medicaid Services (CMS) put out a notice of proposed rule-making for 42 CFR Part 486, specifically the section that covers the organ procurement organization (OPO) Conditions for Coverage. Most crucially, the proposed rule included two new OPO performance metrics using objective, standardized data from the Centers for Disease Control and Prevention (CDC). These new metrics would employ a denominator that included inpatient deaths from certain causes that could lead to organ donation, rather than the current unverifiable eligible death metric. Although there has been near-uniform support for replacing the eligible death denominator with CDC data, a source of contention is CMS's proposal not to adjust risk for race in their OPO outcome. Nonetheless, there have been calls for race and ethnicity to be included as risk-adjusted variables in the CMS donation metric. Herein, we lay out an argument as to why inclusion of race and ethnicity as risk adjustment variables in an OPO performance metric is not only statistically suspect but also will hide the inequities that are detrimental to optimal system performance and assurance that all patients have timely access to donation.
2019 年 12 月，医疗保险和医疗补助服务中心（CMS）发布了一项关于 42 CFR 第 486 部分的拟议规则制定通知，特别是涵盖器官采购组织（OPO）覆盖条件的部分。最重要的是，拟议规则包括了两个新的 OPO 绩效指标，这些指标使用了疾病控制与预防中心（CDC）的客观、标准化数据。这些新指标将采用一个分母，其中包括可能导致器官捐赠的某些原因导致的住院患者死亡，而不是当前不可验证的合格死亡指标。尽管几乎一致支持用 CDC 数据取代合格死亡指标，但存在争议的一个来源是 CMS 提议不在其 OPO 结果中调整种族风险。尽管如此，有人呼吁将种族和民族作为 CMS 捐赠指标的风险调整变量。在此，我们提出了一个论点，即为什么将种族和民族作为 OPO 绩效指标的风险调整变量不仅在统计学上存在疑问，而且还会掩盖对最佳系统性能不利的不平等现象，并确保所有患者都能及时获得捐赠。
