Quality assessment and performance improvement in transplantation: hype or hope?

Healthcare reform and the national quality strategy is increasingly impacting transplant practice, as exemplified by quality assessment and performance improvement (QAPI) regulations for pretransplant and posttransplant care. Transplant providers consider not just patient comorbidities, donor quality, and business constraints, but also regulatory mandates when deciding how to care for transplant candidates and recipients. This review describes transplant quality oversight agencies and regulations, and explores recent literature on the pros and cons of transplant QAPI.

Transplant's heavily regulated system of care and remuneration involves extensive QAPI process and outcome requirements, and assessment of lifelong, risk-adjusted data from the national, audited, publicly reported, electronic registry. Transplant is a model-integrated delivery system, with payment bundling and accountability for equitable access to high quality, efficient, cost-sensitive, and multidisciplinary care. However, transplant QAPI requires expensive resources and, to bolster wise risk-taking, novel treatments, and access to care, more nuanced risk adjustment, public reporting, and attention to geographic competitive variability. However, transplant QAPI requires expensive resources. In order to bolster wise risk-taking, novel treatments, and access to care, QAPI also requires more nuance in the areas of risk adjustment, public reporting, and attention to geographic competitive variability.

With its focus on innovation and on clinical outcomes, transplantation is poised to continue providing outstanding clinical care and to pioneering systems that advance patient safety, satisfaction, and resource utilization, leading in the field of QAPI and healthcare reform.