Journal article
Accountability for end-stage organ care: Implications of geographic variation in access to kidney transplantation
Surgery, Vol.155(5), pp.734-742
05/01/2014
DOI: 10.1016/j.surg.2013.12.010
PMID: 24787099
Abstract
Background. The provision of effective surgical care for end-stage renal disease (ESRD) requires efficient evaluation and transplantation. Prior assessments of transplant access have focused primarily on waitlisted patients rather than the overall populations served by "accountable" providers of transplant services.
Methods. Novel transplant referral regions (TRRs) were defined using United Network for Organ Sharing registry data for 301,092 kidney transplant listings to assign zip codes to "accountable" transplant programs. Subsequently, risk-adjusted observed to expected (0:E) rates of listing and transplant procedures were calculated for each TRR. Finally, the impact of variation in TRR listing and transplant rates on mortality was, assessed for ESRD patients <60 years old diagnosed between 2000 and 2008.
Results. In total, 113 TRRs were defined, 51% of which included >1 transplant center The likelihood of being evaluated and listed for transplant varied significantly between TRRs (risk-adjusted 0:E, 0.58-1.95). Variation was greater for the overall transplant rate (0.62-2.19), living donor transplantation (0.36-3.08), and donation after cardiac death transplant (0-15.4) than for standard criteria donors (0.64-2.86). Mortality was decreased for ESRD patients living in TRRs in the highest tertile of listings (hazard ratio, 0.89; P <.0001) and transplantation (0.90; P <.0001).
Conclusion. Residence in a TRR with care delivery systems that increase access to transplant services is associated with significant, risk-adjusted decreases in ESRD-related mortality. Transplant centers should continue to focus on improving access to care within the communities they serve.
Details
- Title: Subtitle
- Accountability for end-stage organ care: Implications of geographic variation in access to kidney transplantation
- Creators
- David A. Axelrod - Dartmouth–Hitchcock Medical CenterKrista L. Lentine - St Louis Univ, Ctr Outcomes Res, St Louis, MO 63103 USAHuiling Xiao - Saint Louis UniversityThomas Bubolz - Dartmouth Institute for Health Policy and Clinical PracticeDavid Goodman - Dartmouth Institute for Health Policy and Clinical PracticeRichard Freeman - Dartmouth–Hitchcock Medical CenterJanet E. Tuttle-Newhall - Saint Louis UniversityMark A. Schnitzler - Saint Louis University
- Resource Type
- Journal article
- Publication Details
- Surgery, Vol.155(5), pp.734-742
- Publisher
- Elsevier
- DOI
- 10.1016/j.surg.2013.12.010
- PMID
- 24787099
- ISSN
- 0039-6060
- eISSN
- 1532-7361
- Number of pages
- 9
- Grant note
- Hitchcock Foundation
- Language
- English
- Date published
- 05/01/2014
- Academic Unit
- Surgery
- Record Identifier
- 9984322821702771
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