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Data Sourcing and Basis for Performance Measurement

Snyder, J. J., Musgrove, D., Zaun, D., Wey, A., Salkowski, N., Rosendale, J., Israni, A. K., Hirose, R., & Kasiske, B. L. (2020). The Centers for Medicare and Medicaid Services’ Proposed Metrics for Recertification of Organ Procurement Organizations: Evaluation by the Scientific Registry of Transplant Recipients. American Journal of Transplantation, 20(9), 2466–2480. https://doi.org/10.1111/ajt.15842

This evaluation examined how OPOs would have fared under the proposed performance standards in 2016-2017. Data on donors and transplants were from the Organ Procurement and Transplantation Network; donor potential was estimated from Detailed Multiple Cause of Death data collected by the Centers for Disease Control and Prevention. In 2017, 31 (53%) OPOs failed to meet the proposed donation rate standard, 36 (62%) failed to meet the proposed organ transplant rate standard, and 37 (64%) failed at least 1 standard. The study found that adjusting for age, race, and Hispanic ethnicity altered the evaluation: 8 OPOs changed their pass/fail status for the donation rate and 5 for the proposed organ transplant rate standard. The authors concluded that the proposed new standards may result in over half of OPOs facing decertification, and risk adjustment suggests that underlying characteristics of deaths vary regionally such that decertification decisions may be affected.

Arias, E., Heron, M., National Center for Health Statistics, Hakes, J., & U.S. Census Bureau. (2016). The Validity of Race and Hispanic-origin Reporting on Death Certificates in the United States: An Update. Vital and Health Statistics Series, 172. https://www.cdc.gov/nchs/data/series/sr_02/sr02_172.pdf.

This report presents the findings of an updated study of the validity of race and Hispanic-origin reporting on death certificates in the United States, and its impact on race- and Hispanic origin-specific death rates. Misclassification remained high at 40% for the American Indian or Alaska Native (AIAN) population. Decedent characteristics such as place of residence and nativity affected the quality of reporting on the death certificate. Effects of misclassification on death rates were large for the AIAN population but not significant for the Hispanic or API populations.

Lloyd, J., Jahanpour, E., Angell, B., Ward, C., Hunter, A., Baysinger, C., & Turabelidze, G. (2017). Using National Inpatient Death Rates as a Benchmark to Identify Hospitals with Inaccurate Cause of Death Reporting — Missouri, 2009–2012. Morbidity and Mortality Weekly Report, 66(1), 19–22. https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6601a5.pdf.

The article describes the Missouri Department of Health and Senior Services (DHSS)’s efforts to analyze inpatient death rates reported by hospitals with high inpatient death rates in the St. Louis and Kansas City metro areas. Selected hospitals with high inpatient death rates were more likely to over report heart disease and renal disease, and underreport cancer as an underlying cause of death. A new web based training module for death certificate completion was initiated in the state for all personnel involved in death records data entry.

Adeyinka, A., & Bailey, K. (2021). Death Certification. In StatPearls. essay, StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526015/.

This chapter in StatPearls indicates that about 33-41% of cases, errors are made on the death certificate. There is a significant over-representation of cardiovascular diseases as the primary cause of death. The most cited reasons for errors in death certification are inexperienced physician and lack of training by attending physicians. This chapter indicates that studies suggest organizing seminars and workshops that teach the process and procedure involved in death certification can improve documentation accuracy.

Sheehy, E., Conrad, S. L., Brigham, L. E., Luskin, R., Weber, P., Eakin, M., Schkade, L., & Hunsicker, L. (2003). Estimating the Number of Potential Organ Donors in the United States. New England Journal of Medicine, 349(21), 2073–2075. https://doi.org/10.1056/nejm200311203492117

An examination of medical records of deaths occurring in the intensive care unit from 1997 through 1999 in the service areas of 36 organ-procurement organizations identified 18,524 brain-dead potential organ donors. The overall consent rate (the number of families agreeing to donate divided by the number of families asked to donate) for 1997 through 1999 was 54 percent, and the overall conversion rate (the number of actual donors divided by the number of potential donors) was 42 percent. Hospitals with 150 or more beds were more likely than smaller hospitals to have potential donors and actual donors (P<0.001); 19 percent of hospitals accounted for 80 percent of all potential donors. Calculations of the number of donors per million persons in the general population did not correlate well with the performance of organ-procurement organizations as measured by the conversion rate.

Siminoff, L. A., Gardiner, H. M., Wilson-Genderson, M., & Shafer, T. J. (2018). How Inaccurate Metrics Hide the True Potential for Organ Donation in the United States. Progress in Transplantation, 28(1), 12–18. https://doi.org/10.1177/1526924818757939

This article examines the discrepancy between the reported increase in donor conversion rates and the number of organs available for transplant. A secondary analysis of data obtained from the Scientific Registry of Transplant Recipients from January 2003 through December 2015 was performed and found that the number of brain-dead donors increased from 6187 to 7375, remaining relatively stable at approximately 7200 thereafter. Additionally, the average eligible deaths per organ procurement organization dropped from 182.7 (standard deviation [SD]: 131.3) in 2003 to 149.3 (SD: 111.4) in 2015. From 2006 to 2015, the data indicate an artificial depression and underestimation of the true potential of brain-dead donors in the United States of conservatively 12,493 donors or 39,728 missing organs.