Division of Transplant Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora.
Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
JAMA Netw Open. 2023 Oct 2;6(10):e2336749. doi: 10.1001/jamanetworkopen.2023.36749.
In 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule updating the Organ Procurement Organization (OPO) Conditions for Coverage. This rule evaluates OPO performance based on an unadjusted donation rate and an age-adjusted transplant rate; however, neither considers other underlying population differences.
To evaluate whether adjusting for age and/or area deprivation index yields the same tier assignments as the cause, age, and location consistent (CALC) tier used by CMS.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study examined the performance of 58 OPOs from 2018 to 2020 across the entire US. A total of 12 041 778 death records were examined from the 2017 to 2020 National Center for Health Statistics' Restricted Vital Statistics Detailed Multiple Cause of Death files; 399 530 of these met the definition of potential deceased donor. Information about 42 572 solid organ donors from the Scientific Registry of Transplant Recipients was also used. Statistical analysis was performed from January 2017 to December 2020.
Area deprivation of donation service areas and age of potential donors.
OPO performance as measured by donation and transplant rates.
A total of 399 530 potential deceased donors and 42 572 actual solid donor organs were assigned to 1 of 58 OPOs. Age and ADI adjustment resulted in 19.0% (11 of 58) to 31.0% (18 of 58) reclassification of tier ratings for the OPOs, with 46.6% of OPOs (27 of 58) changing tier ranking at least once during the 3-year period. Between 6.9% (4 of 58) and 12.1% (7 of 58) moved into tier 1 and up to 8.6% (5 of 58) moved into tier 3.
This cross-sectional study of population characteristics and OPO performance metrics found that adjusting for area deprivation and age significantly changed OPO measured performance and tier classifications. These findings suggest that underlying population characteristics may alter processes of care and characterize donation and transplant rates independent of OPO performance. Risk adjustment accounting for population characteristics warrants consideration in prospective policy and further evaluation of quality metrics.
2020 年，医疗保险和医疗补助服务中心（CMS）发布了一项最终规则，更新了器官采购组织（OPO）的覆盖范围条件。该规则根据未经调整的捐赠率和年龄调整的移植率来评估 OPO 的表现；然而，两者都没有考虑到其他潜在的人口差异。
评估根据年龄和/或地区贫困指数进行调整是否会产生与 CMS 使用的因果、年龄和位置一致（CALC）级别相同的分级分配。
设计、设置和参与者：这项回顾性的横断面研究调查了 2018 年至 2020 年期间美国各地 58 个 OPO 的表现。从 2017 年至 2020 年国家卫生统计中心的受限生命统计详细多原因死亡文件中检查了总共 12041778 份死亡记录；其中 399530 份符合潜在死亡捐赠者的定义。还使用了来自移植受者科学注册处的 42572 名实体器官供者的信息。统计分析于 2017 年 1 月至 2020 年 12 月进行。
捐赠服务区域的地区贫困和潜在供者的年龄。
OPO 表现，以捐赠率和移植率衡量。
共有 399530 名潜在死亡捐赠者和 42572 名实际实体供者被分配到 58 个 OPO 中的 1 个。年龄和 ADI 调整导致 OPO 的分级评定重新分类率为 19.0%（58 个中的 11 个）至 31.0%（58 个中的 18 个），其中 46.6%（58 个中的 27 个）的 OPO 在 3 年期间至少改变了一次分级排名。在 6.9%（58 个中的 4 个）至 12.1%（58 个中的 7 个）之间进入 1 级，最多有 8.6%（58 个中的 5 个）进入 3 级。
这项关于人口特征和 OPO 绩效指标的横断面研究发现，对地区贫困和年龄进行调整显著改变了 OPO 的测量表现和分级分类。这些发现表明，潜在的人口特征可能会改变护理过程，并独立于 OPO 的表现来描述捐赠和移植率。考虑到人口特征的风险调整应在未来的政策中考虑，并进一步评估质量指标。
