Quality Metrics in Solid Organ Transplantation: A Systematic Review

Area of Science:

• Transplantation Medicine
• Healthcare Quality Improvement
• Health Services Research

Background:

• Determining high-quality care in transplant programs remains a challenge.
• A comprehensive understanding of existing quality metrics in solid organ transplantation is lacking.

Purpose of the Study:

• To identify and characterize quality metrics used in solid organ transplantation.
• To evaluate the development, definition, and application of these metrics.

Main Methods:

• Systematic literature search of Medline, Embase, and Cochrane Central Register of Controlled Trials.
• Inclusion of full-text reports and conference abstracts on organ transplantation quality metrics.
• Independent data extraction by two reviewers from 52 full-text reports and 24 abstracts.

Main Results:

• Identified 317 quality metrics, condensed into 114 unique indicators.
• Many metrics lacked detailed development information, clear definitions, or consistent application.
• Only 5 publications described metric selection processes, and only 1 involved patient input.
• Few metrics were assessed against patient and graft survival outcomes.

Conclusions:

• Despite numerous reported metrics, significant deficiencies exist in their development, definition, and transparency.
• Current metrics predominantly focus on safety and effectiveness, neglecting domains like equity and patient-centeredness.
• Future research must prioritize transparent, objective metric development, rigorous testing, and patient engagement to enhance transplantation quality assessment.