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Program-specific reports: implications and impact on program behavior

VanWagner, Lisa B.; Skaro, Anton I.

Current Opinion in Organ Transplantation:
doi: 10.1097/MOT.0b013e32835f07f8
REGULATORY, FINANCIAL AND ETHICAL CONSIDERATIONS IN TRANSPLANTATION: Edited by Anton I. Skaro
Abstract

Purpose of review: Measuring and monitoring transplant center performance is vital to ongoing quality assessment and performance improvement initiatives geared toward ensuring optimal care for patients with end-stage organ failure. The impact of regulatory oversight on transplant center behavior and programmatic decision-making is complex.

Recent findings: Program-specific reports (PSRs) are published by the Scientific Registry for Transplant Recipients (SRTR) and are publically available for use by a variety of stakeholders, including patients, regulators, insurers, and care providers. PSRs have been both groundbreaking and controversial. The principal areas of concern relate to potential unintended consequences of PSRs, limitations in both the data collected by the registry and the currently used statistical methodology employed by the SRTR for risk adjustment, and the subsequent impact on transplant program behavior.

Summary: PSRs, which serve the purposes of fueling ongoing performance improvement initiatives and informing consumers and payers by fostering transparency in the communication of risk, also involve trade-offs because of their unintended use for regulatory oversight and subsequent impact on transplant center behavior. Future research is necessary to improve data integrity and risk-adjustment methodologies which will enhance regulation and preserve access to transplantation among vulnerable patient populations.

Author Information

Comprehensive Transplant Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA

Correspondence to Anton I. Skaro, MD, PhD, Assistant Professor of Surgery, Director of Quality Assessment and Performance Improvement, Director of Vascular Access Surgery, Associate Director of Kidney and Pancreas Transplantation, Comprehensive Transplant Center, Northwestern University, Feinberg School of Medicine, Arkes Family Pavilion, Suite 19-087, 676 North St. Clair Street, Chicago, IL 60611-2923, USA. Tel: +1 312 926 4272; fax: +1 312 695 9194; e-mail: askaro@nmh.org

© 2013 Lippincott Williams & Wilkins, Inc.