TY - JOUR
T1 - Kidney offer acceptance at programs undergoing a Systems Improvement Agreement
AU - Bowring, Mary G.
AU - Massie, Allan B.
AU - Craig-Schapiro, Rebecca
AU - Segev, Dorry L.
AU - Nicholas, Lauren Hersch
N1 - Funding Information:
The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy of or interpretation by the SRTR, United Network for Organ Sharing (UNOS/OPTN), or the U.S. Government. This work was supported in part by the Laura and John Arnold Foundation. D.L. Segev and A.B. Massie are supported by grant numbers K24DK101828 and K01DK101677 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), respectively. L.H. Nicholas is supported by grant number K01AG041763 from the National Institute on Aging.
PY - 2018/9
Y1 - 2018/9
N2 - In the United States, the Centers for Medicare and Medicaid Services (CMS) use Systems Improvement Agreements (SIAs) to require transplant programs repeatedly flagged for poor-performance to improve performance or lose CMS funding for transplants. We identified 14 kidney transplant (KT) programs with SIAs and 28 KT programs without SIAs matched on waitlist volume and characterized kidney acceptance using SRTR data from 12/2006-3/2015. We used difference-in-differences linear regression models to identify changes in acceptance associated with an SIA independent of program variation and trends prior to the SIA. SIA programs accepted 26.9% and 22.1% of offers pre- and post-SIA, while non-SIA programs accepted 33.9% and 44.4% of offers in matched time periods. After adjustment for donor characteristics, time-varying waitlist volume, and secular trends, SIAs were associated with a 5.9 percentage-point (22%) decrease in kidney acceptance (95% CI: −10.9 to −0.8, P =.03). The decrease in acceptance post-SIA was more pronounced for KDPI 0-40 kidneys (12.3 percentage-point decrease, P =.007); reductions in acceptance of higher KDPI kidneys occurred pre-SIA. Programs undergoing SIAs substantially reduced acceptance of kidney offers for waitlisted candidates. Attempts to improve posttransplant outcomes might have the unintended consequence of reducing access to transplantation as programs adopt more restrictive organ selection practices.
AB - In the United States, the Centers for Medicare and Medicaid Services (CMS) use Systems Improvement Agreements (SIAs) to require transplant programs repeatedly flagged for poor-performance to improve performance or lose CMS funding for transplants. We identified 14 kidney transplant (KT) programs with SIAs and 28 KT programs without SIAs matched on waitlist volume and characterized kidney acceptance using SRTR data from 12/2006-3/2015. We used difference-in-differences linear regression models to identify changes in acceptance associated with an SIA independent of program variation and trends prior to the SIA. SIA programs accepted 26.9% and 22.1% of offers pre- and post-SIA, while non-SIA programs accepted 33.9% and 44.4% of offers in matched time periods. After adjustment for donor characteristics, time-varying waitlist volume, and secular trends, SIAs were associated with a 5.9 percentage-point (22%) decrease in kidney acceptance (95% CI: −10.9 to −0.8, P =.03). The decrease in acceptance post-SIA was more pronounced for KDPI 0-40 kidneys (12.3 percentage-point decrease, P =.007); reductions in acceptance of higher KDPI kidneys occurred pre-SIA. Programs undergoing SIAs substantially reduced acceptance of kidney offers for waitlisted candidates. Attempts to improve posttransplant outcomes might have the unintended consequence of reducing access to transplantation as programs adopt more restrictive organ selection practices.
KW - Organ Procurement and Transplantation Network (OPTN)
KW - Scientific Registry for Transplant Recipients (SRTR)
KW - clinical decision-making
KW - clinical research/practice
KW - ethics and public policy
KW - kidney transplantation/nephrology
KW - organ acceptance
KW - organ procurement and allocation
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U2 - 10.1111/ajt.14907
DO - 10.1111/ajt.14907
M3 - Article
C2 - 29718565
AN - SCOPUS:85052532025
VL - 18
SP - 2182
EP - 2188
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 9
ER -