Transplant center quality assessment using a continuously updatable, risk-adjusted technique (CUSUM)

Area of Science:

• Transplantation Science
• Medical Quality Improvement
• Biostatistics

Background:

• Effective quality improvement in organ transplantation relies on timely, risk-adjusted outcome measures.
• The cumulative summation (CUSUM) technique offers a sensitive approach to detect sustained performance changes in transplant centers.

Purpose of the Study:

• To evaluate the utility of the CUSUM technique for monitoring risk-adjusted outcomes in kidney and liver transplant centers.
• To compare CUSUM performance detection with the existing Organ Procurement and Transplantation Network (OPTN) method.

Main Methods:

• Utilized Scientific Registry of Transplant Recipients data for adult kidney (N=258) and liver (N=114) transplants from 1997-2001.
• Employed logistic regression to predict 1-year graft failure (kidney) and mortality (liver), adjusting for risk factors.
• Constructed risk-adjusted CUSUM charts and compared identified centers with OPTN's semi-annual reporting.

Main Results:

• CUSUM identified significant performance changes in 92 kidney centers (improving) and 52 (declining).
• CUSUM identified significant performance changes in 48 liver centers (improving) and 24 (declining).
• CUSUM successfully flagged most centers identified by the OPTN method (20/22 kidney, 8/11 liver).

Conclusions:

• The CUSUM technique is a valuable tool for transplant quality improvement.
• CUSUM enables the identification of clinically important, risk-adjusted shifts in transplant center outcomes over time.