Niroomand Elaheh, Mantero Alejandro, Narasimman Manasa, Delgado Cindy, Goldberg David
Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida.
Am J Transplant. 2020 Dec;20(12):3567-3573. doi: 10.1111/ajt.16085. Epub 2020 Jul 5.
Recently proposed rulemaking from Centers for Medicare and Medicaid Services would change how organ procurement organizations (OPOs) are evaluated. The proposals include using national inpatient death data to define a standardized denominator to calculate comparable donation rates among OPOs. Based on these objective metrics, OPOs not performing at a prespecified threshold will be required to rapidly improve performance to avoid decertification. We sought to determine whether rapid OPO improvement was possible based on objective donation metrics, and whether leadership change was associated with rapid improvement. We evaluated United Network for Organ Sharing and Centers for Disease Control and Prevention (CDC) data from 2011 to 2018, and measured donation rates using CDC data on inpatient deaths from causes consistent with donation, based on the location of deaths. During the two 4-year cycles, we found that an OPO's ranking relative to other OPOs was fairly static, with more than 90% of the OPOs at risk of flagging at the end of each 4-year cycle (2014, 2018) being in the bottom 75% of OPOs in the preceding 3 years. In multivariable logistic regression models, leadership changes were only statistically significantly associated with an improvement in OPO rankings during the 2011-2014 cycle. These data demonstrate that rapid improvements in OPO performance are uncommon, and while leadership changes increase the odds of rapid improvement, they do not guarantee improvement.
医疗保险和医疗补助服务中心最近提出的规则制定将改变对器官获取组织（OPO）的评估方式。这些提议包括使用全国住院患者死亡数据来定义一个标准化分母，以计算各OPO之间可比的捐赠率。基于这些客观指标，未达到预先设定阈值的OPO将被要求迅速提高绩效，以免被取消认证。我们试图确定基于客观捐赠指标，OPO能否迅速改进，以及领导层变动是否与迅速改进相关。我们评估了器官共享联合网络和疾病控制与预防中心（CDC）2011年至2018年的数据，并根据死亡地点，使用CDC关于符合捐赠条件病因的住院患者死亡数据来衡量捐赠率。在两个4年周期内，我们发现一个OPO相对于其他OPO的排名相当稳定，在每个4年周期（2014年、2018年）结束时，超过90%有被标记风险的OPO在前3年处于OPO排名的后75%。在多变量逻辑回归模型中，只有在2011 - 2014周期内，领导层变动与OPO排名的改善在统计学上有显著关联。这些数据表明，OPO绩效的迅速改善并不常见，虽然领导层变动增加了迅速改善的几率，但并不能保证一定会改善。
