ArticleHealth services research2019
Quality-based ratings in Medicare and trends in kidney transplantation.
Article in Health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Patient selection in the presence of regulatory oversight based on healthcare report cards of providers: the case of organ transplantation.Health care management science · 2021Article
- Quality-based ratings in Medicare and trends in kidney transplantation.Health services research · 2019Article
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Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the relationship between the 2007 Medicare regulation enforcing quality standards for transplant centers and trends in kidney transplantation. DATA SOURCES: Transplant centers' biannual reports and the national registry for kidney transplantation from 2003 to 2010. STUDY
designNon-compliant (low-performing) centers were compared with centers in compliance with quality standards according to: number of transplants, waiting-list registrations, and rates of graft failures, transfers, and deaths. Multivariate regressions were estimated to evaluate the association between the regulation and transplantation outcomes. DATA EXTRACTION
methodsPatient characteristics and outcomes were aggregated to six-month periods and linked to centers' reports. PRINCIPAL
findingsRelative to average-performing centers, 12 percent of transplants shifted away from low-performing centers and high-performing centers captured 6 percent of this decline. Low-performing centers experienced a 2-percentage point per period decline in 1-year graft failure rates and a 15-percent decrease in registrations post-regulation, whereas high-performing centers incurred a 5-percent decrease in registrations relative to average-performing centers.
conclusionsGovernment oversight in kidney transplantation was associated with a small downward shift in overall kidney transplants. Reductions in graft failure rates at low-performing centers may imply an increase in quality or a decline in transplantation of either marginal organs or riskier patients; whereas reductions in registrations may indicate risk aversion toward high-risk patients. Policy makers should consider making less punitive requirements for programs, which employ new transplantation techniques to expand access.
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