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2023 Studies
Below are curated studies from 2023.
Population Characteristics and Organ Procurement OrganizationPerformance Metrics
Rocio Lopez, MS, MPH; Sumit Mohan, MD, MPH; Jesse D. Schold, PhD, MStat, Med; JAMA Network Open. 2023;6(10):e2336749. doi:10.1001/jamanetworkopen.2023.36749 October 3, 2023 1/13, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809988
Summary
The CMS OPO rule evaluates performance based on an unadjusted donation rate and an age-adjusted transplant rates.
The study evaluates whether adjusting for age and/or area deprivation index yields the same tier assignments as the cause, age, and location consistent (CALC) tier used by CMS.
Age and ADI adjustment resulted in 19.0% to 31.0% reclassification of tier ratings for the OPOs, with 46.6% of OPOs changing tier ranking at least once during the 3-year period. Between 6.9% and 12.1% moved into tier 1 and up to 8.6%(5 of 58) moved into tier 3.
OPO Measured Donation Rate is Highly Volatile Year to Year and Not a Stable Quality Indicator
J. Schold, R. Lopez, University of Colorado, Aurora, CO S. Mohan, Columbia University Medical Center, New York, NY ; American Journal of Transplantation (AJT), Volume 23, Issue 6, Supplement 1. Pg. S615, Abstract A5, https://www.amjtransplant.org/article/S1600-6135(23)00475-6/fulltext
Summary
With new CMS regulations, Organ Procurement Organizations (OPO) are to be evaluated yearly and certified/decertified every 4 years based on a single year’s data.
The purpose of this study was to assess the volatility of annual evaluations.
OPOs’ donor potential and donor rate are not stable year to year and 24/58 OPOs lie within 5% of a tier edge with many OPOs having shifts in donor potential >5%.
The consequence of yearly measurement may result in well-functioning OPOs inadvertently being decertified.
Significant Discrepancies to Evaluate Organ Procurement Organization Performance Based on Exclusion Criteria
J. D. Schold, University of Colorado, Aurora, CO R. Lopez, D. Zingmond, , 2 University of California Los Angeles, Los Angeles, CA. AJT, Volume 23, Issue 6, Supplement 1. Pg. S930, Abstract C55, https://www.amjtransplant.org/article/S1600-6135(23)00475-6/fulltext
Summary
We sought to evaluate whether incorporating data with exclusions (CALC or CALC-adjusted) produce the same tier assignments, which determines OPO certification or decertification.
11/21 OPOs (52%) have greater than 5% difference in actual versus predicted donors. As a result, 29% (6/21) of OPOs change tiers using donor potential measured by CALC compared to that measured by CALC-adjusted.
Conclusions: Contraindicating exclusion factors are not equal across OPO service areas. Current tier assignments using CALC may be unreliable compared to those calculated by CALC-adjusted, using a large sample of OPOs across the country.
Impact of Area Deprivation Index on Organ Procurement Organization Performance Metrics
J. Schold, University of Colorado Anschutz Medical Campus, Aurora, CO, R. Lopez, University of Colorado, Aurora, CO, S. Mohan, Columbia University Medical Center, New York, NY; American Journal of Transplantation (AJT), Volume 23, Issue 6, Supplement 1. Pg S471, Abstract 273, https://www.amjtransplant.org/article/S1600-6135(23)00474-4/fulltext
Summary
The purpose of this study was to evaluate if applying an ADI-adjustment yields the same tier assignments as the metrics used by CMS.
Compared to unadjusted donation rate and age-adjusted transplantation rate, additional ADI-adjustment resulted in 16% to 41% of OPOs changing tiers (figure) each year. Between 1-2 OPOs moved out of tier 1 and 3-7 moved into tier 1 each year.
ADI-adjustment of performance metrics significantly alters OPO tier assignments.
Cordance by Data Source for Defining Donor Potential Using Cause, Age, and Location Consistent with Donation Used for New CMS OPO Regulations
J. Schold, University of Colorado, Aurora, R. Lopez, University of Colorado, Aurora, D. Zingmond, University of California Los Angeles, Los Angeles, CA; American Journal of Transplantation (AJT), Volume 23, Issue 6, Supplement 1. Pg. S607, Abstract 566, https://www.amjtransplant.org/article/S1600-6135(23)00474-4/fulltext
Summary
The purpose of this study is to assess whether CALC is a sufficiently reliable and objective determination of donor potential on which to make OPO decertification decisions.
Approximately 20% of OPOs changed tiers with State Independent Databases (SID) as compared to final rule (figure). Similar results are seen with transplant and overall tiers.
Tier assignments significantly change OPOs are reclassified for performance based on the different data sources. Given the structure of the tiering system and the significant ramifications, CMS should revisit their decision to use CALC for certification decisions.
Stability of New CMS Metrics for Organ Procurement Organizations: Comparison of 2 Consecutive Years
A. Israni, J. Snyder, Hennepin Healthcare, Univ of MN, Scientific Registry of Transplant Recipients, Minneapolis, MN; American Journal of Transplantation (AJT), Volume 23, Issue 6, Supplement 1. Pg. S609 Abstract 571, https://www.amjtransplant.org/article/S1600-6135(23)00475-6/fulltext
Summary
We compared the stability of tiers for the new CMS metrics for donation rate and transplant rate between 2019 and 2020.
For the donation rate metric, between 2019 and 2020, 67% of the OPOs stayed consistent in their tiers and 33% changed tiers. For the overall tiers, 59% stayed consistent and 41% changed tiers.
Illustrating a limitation of using the prior year to set the performance targets.
Adjusting for Race in Metrics of Organ Procurement Organization Performance
J. Miller 1, D. Zaun 1, N. Wood 1, G. Lyden 1, W. T. McKinney 2, J. Snyder 1, 1 Scientific Registry of Transplant Recipients, Minneapolis, MN, 2 Nephrology, Hennepin Healthcare Research Institute, Minneapolis, MN; American Journal of Transplantation (AJT), Volume 23, Issue 6, Supplement 1. Pg S620, Abstract ALB2 https://www.amjtransplant.org/article/S1600-6135(23)00475-6/fulltext,
Summary
The CMS OPO donation rate metric is unadjusted, and the transplant rate metric is adjusted for age only. This study examines the impact of additionally adjusting these metrices for race.
Nationally, donation rates and transplant rates were higher among White potential donors than non-White potential donors.
When adjusting for race, 8 OPOs changed tiers (5 improved their tier, 3 lowered their tier).
Failing to adjust for race risks extreme penalties for OPOs that have high proportions of non-White potential donors.