Enhance Transplant Program Performance Monitoring System

At a glance

Current policy

The Membership and Professional Standards Committee (MPSC) evaluates transplant program performance using one-year after transplant patient and organ outcomes.  Members have questioned whether the use of one measure sufficiently assesses program performance. Other members have suggested that relying only on after transplant outcomes may result in less transplants. The MPSC proposal wants to establish a more comprehensive system that evaluates several parts of transplant program performance.

Supporting media

Rich Formica, M.D., presents an overview of the proposal on behalf of the MPSC.

View presentation

Watch MPSC Performance Monitoring Improvement Subcommittee chair Rich Formica's Aug. 4 webinar presentation that provides a more detailed overview of the MPSC's proposal.

Ian Jamieson, MPSC Chair, and Jon Snyder, Director of the SRTR, discuss the four evaluation metrics involved in the proposal, describe the models used to produce these metrics, and answer a number of common questions.

View the presentation slide deck (PDF)

Proposed changes

• Establishes four metrics that measure program performance before and after transplant
• Sets separate adult and child criteria to identify potential patient safety issues
• Reviews a transplant program if the program meets any new criteria
• Provides an additional performance improvement zone to notify programs of concerning trends and offer assistance, if requested
• Documents existing peer visit process in the bylaws

Anticipated impact

• What it's expected to do
  • Increase number of transplants
  • Reduces emphasis on after transplant outcomes
  • Fulfills the MPSC’s obligation to monitor member performance and identify patient safety issues
  • Provides opportunities for the OPTN and the MPSC to support and work with transplant programs for better outcomes
• What it won't do
  • Does not increase the number of transplant programs that have to work with the MPSC due to underperformance
  • Does not affect the metrics available or the 5 tier outcome assessments on the Scientific Registry of Transplant Recipients (SRTR) website

Themes

• Holistic transplant program performance monitoring
• Patient health and public safety
• Performance improvement assistance

Terms to know

• Waiting list mortality rate ratio: Describes risk of death once candidates are listed but before they are transplanted. The waiting list mortality rate ratio estimates the program’s waiting list mortality relative to the national expectations.
• Offer acceptance rate ratio: Indicates whether a program is more or less likely to accept offers than the national average. If the offer acceptance ratio is greater than 1.0, then the program tends to accept more offers than average; if the offer acceptance ratio is less than 1.0, then the program tends to accept fewer offers than average.
• 90-day graft survival hazard ratio: Provides an estimate whether the program has higher or lower than expected organ failure rates during the first 90-days after transplant as compared to transplant outcomes for all U.S. transplant programs. Organ failure numbers include organ failures, retransplants and patient deaths.
• One-year graft survival conditional on 90-day graft survival hazard ratio: Provides an estimate whether the program has higher or lower than expected graft failure rates during the the first year after transplant.

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