Transplant Center Quality Assessment: Correlation Between Early Graft Outcomes and Patient-Centered Assessments of Hospital Care
1Surgery, Mayo Clinic Arizona, Phoenix, AZ
2Surgery, University of Michigan, Ann Arbor, MI.
Meeting: 2015 American Transplant Congress
Abstract number: A234
Keywords: Graft survival, Multivariate analysis, Outcome, Public policy
Session Information
Date: Saturday, May 2, 2015
Session Name: Poster Session A: Non Organ Specific, Economics, Public Policy, Allocation, Ethics
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Background: Patients selecting a transplant center use public reports of outcomes to empower their decision-making. Patient-focused quality measures are lacking in transplantation, but are a focal point of public reporting by CMS. We aimed to determine whether patient perspectives on hospital quality correlate with kidney transplant center performance.
Methods: CMS sponsors the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a national survey of patients' perspectives on hospital care. We merged 2012 SRTR kidney transplant center-level data (n=200 centers) with the 2012 HCAHPS and the American Hospital Association surveys. Variation in observed to expected (O/E) ratios for 1-month graft failure was recorded in quintiles. We used multivariate logistic regression to determine whether HCAHPS measures were predictive of kidney transplant center performance, after adjusting for hospital structural characteristics and volume.
Results: Across all centers, graft failure varied significantly (O/E range: 0-4.1). 70% of HCAHPS measures and transplant center volume varied across center performance quintiles, respectively (p< 0.05). Compared to average kidney transplant centers, hospitals with always clean rooms (OR 1.26, p=0.001), hospitals recommended by patients (OR 1.18, p=0.005) and hospitals rated highly (OR 1.11, p=0.036) had greater risk-adjusted odds of being high performing. Conversely, hospitals with poor nursing-patient communication (OR 0.70, p=.030), poor room cleanliness (OR 0.67, p<0.001), poor patient ratings (OR .79, p=0.038), and a lack of overall hospital endorsement by patients (OR 0.68, p=0.019) had significantly lower risk-adjusted odds of being a high performing transplant center.
Overall, 3 of 8 HCAHPS domains could discriminate low, average, and high transplant center performance, namely patient ratings of nurse communication, hospital cleanliness, and overall hospital rating.
Conclusions: To a moderate extent, after adjusting for center volume and structural characteristics, patient perspectives on hospital care are associated with transplant center performance in kidney transplantation. Further development of specific patient-centered outcome measures in transplantation may help better define quality of care, beyond SRTR reports and traditional metrics.
To cite this abstract in AMA style:
Mathur A, Chakrabarti A, Sheetz K, Katariya N, Singer A, Hewitt W, Reddy K, Moss A. Transplant Center Quality Assessment: Correlation Between Early Graft Outcomes and Patient-Centered Assessments of Hospital Care [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/transplant-center-quality-assessment-correlation-between-early-graft-outcomes-and-patient-centered-assessments-of-hospital-care/. Accessed November 30, 2020.« Back to 2015 American Transplant Congress