Utility of Ecological Risk Factors for Evaluation of Transplant Center Performance

Area of Science:

• Public Health
• Health Services Research
• Transplant Medicine

Background:

• Social determinants of health (SDOH) are linked to U.S. morbidity and mortality.
• SDOH variations across regions and communities affect healthcare quality measurement.
• Providers treating vulnerable populations may face disadvantages due to lack of risk adjustment.

Purpose of the Study:

• To advocate for the integration of ecological (area-level) factors into risk adjustment models for transplant center quality assessment.
• To address disparities in healthcare access and improve the accuracy of quality evaluations.

Main Methods:

• This viewpoint discusses the implications of SDOH on healthcare quality metrics.
• It proposes the inclusion of area-level factors in risk adjustment models.
• The argument is supported by the National Quality Forum's endorsement of sociodemographic risk adjustment.

Main Results:

• Current risk adjustment models may unfairly penalize centers treating vulnerable populations.
• Integrating ecological factors can lead to more equitable assessments of transplant center quality.
• This approach can reduce disincentives for providers to treat patients from underserved communities.

Conclusions:

• Integrating ecological factors into risk adjustment models is crucial for transplant center quality assessment.
• This reform can mitigate disparities in access to care.
• Improved risk adjustment and model calibration will enhance the evaluation of transplant centers.