Wide gaps remain between the best and worst transplant clinics

Highlights• Public reporting of the successes and failures of transplant centers has not diminished the gaps between the best and worst centers• If each center’s performance matched that of the best center, about a third of deaths and organ failures could be averted • Additional studies are needed to investigate why public reports have not reduced differences across transplant centers

Newswise — Washington, DC (Day Date, 2011) — When transplant clinics must publicly report their success rates, this should provide an incentive to improve care for patients. But a recent study appearing in the Clinical Journal of the American Society Nephrology (CJASN) found that such public reporting has not had any effect on the care that transplant patients receive.

Public reports of the successes and failures of clinics can help patients choose where they want to receive medical care. Reports can also help the clinics themselves correct their shortcomings to improve the care they provide. But such reports are only useful if they contain accurate information.

Constantia Petrou, PhD (Culmini Inc.), Stefanos Zenios, PhD (Culmini Inc. and Stanford University) and their colleagues compared the accuracy of two methods that can be used in public reporting of transplant centers. They found that the current method that is widely used is less accurate than a new method (called a generalized mixed effect method) that can provide a more realistic assessment of differences across centers. Using and improving this new method and communicating its results to kidney specialists who recommend transplant centers to their patients could strengthen the effectiveness of public reports.

The new method revealed that the gaps between the best and worst clinics did not diminish after public reporting was introduced in 2001. The authors advocate for additional studies to investigate why public reports have not reduced differences across transplant centers. “If public reports did become effective and each center’s outcomes matched those of the center with the best outcomes, 29% of deaths and 33% of organ failures could be averted,” said Dr. Petrou. “Missing such potential improvements is like having one Boeing 747 with transplant recipients crash every year,” she explained.

Study co-authors include Charles McCulloch, PhD (University of California San Francisco) and Glenn Atias (Culmini Inc.).

Disclosures: This research was supported in part by grants NIH 2R44DK07209-01 and 2R44DK07209-02. Dr. Zenios and Dr. Petrou own equity at Culmini, Dr. Atias is an independent contractor for Culmini, and Dr. McCulloch receives consulting fees from Culmini. Culmini develops web tools (Konnectology, http://www.konnectology.com) to support public reporting of outcomes to patients and physicians.

The article, entitled “Outcome Differences Across Transplant Centers: Comparison of Two Methods for Public Reporting,” is published online at http://cjasn.asnjournals.org/, doi:10.2215/​CJN.00300111.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 12,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

MEDIA CONTACT
Register for reporter access to contact details
CITATIONS

Clinical Journal of the American Society Nephrology (doi: 10.2215/​CJN.00300111)