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对心脏移植中心绩效的公开报告:促进清晰度还是引起混乱?
Shahnawaz Amdani1, Elizabeth N Dewey2, Jesse D Schold3
1Children's Institute Department of Heart, Vascular and Thoracic, Division of Cardiology and Cardiovascular Medicine, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
JACC. Heart failure
|April 13, 2024
概括
公共心脏移植中心的评级非常不一致和不可靠. 这些绩效指标,包括等候名单存活率和移植失败率,经常发生变化,需要对当前报告系统进行重大修订.
科学领域:
- 器官移植研究器官移植研究
- 医疗保健质量评估 医疗保健质量评估
- 公共卫生报告报告.
背景情况:
- 公共可用的移植中心报告卡向监管机构,纳税人,患者和家属提供信息.
- 这些绩效评级对于器官移植的决策至关重要.
研究的目的:
- 评估儿童和成人心脏移植中心公开报告的绩效评级的变化.
- 评估关键移植绩效指标的稳定性,波动性和可靠性.
主要方法:
- 利用了来自移植受体科学注册 (2017-2021) 的项目具体报告.
- 分析了三个公共评级:等候名单生存率 (WS),更快地进行移植 (FT) 和移植后移植失败 (GF).
- 评估评级变化,变化时间以及统计一致性和可靠性的统计措施.
主要成果:
- 几乎所有的 (98%) 成人和儿科中心在研究期间经历了评级变化.
- 等候名单生存率 (WS) 在成人和儿科中心表现出最高的波动性.
- 在大多数评级中观察到不良的一致性 (弗莱斯卡帕<0.20) 和可靠性 (类内相关系数<0.50).
结论:
- 目前的5层移植中心绩效报告显示出显著的波动性,缺乏可靠性.
- 这些评级的不一致性可能会给患者和提供者带来意想不到的负面影响.
- 需要对当前的移植中心绩效评级系统进行批判性修订.
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