ONGOING STUDIES
The Effect of Broader Geographic Organ Sharing on Survival for Lung Transplant Candidates
Our previous work demonstrated that over 80% of donor lungs were allocated to low-priority candidates (LAS < 50). Concurrently, high-priority candidates (LAS > 75) continue to die at high rates on the waiting list (nearly 50% at one year). These findings are particularly troubling because we previously showed low-priority candidates appear to receive little, or no, net survival benefit from transplant. In an effort to identify mechanisms to further improve the lung allocation system and therefore increase the survival benefit from transplantation, this proposal describes a series of analyses intended to explore the impact of local allocation of organs on waitlist outcome. By adapting advanced statistical methods, we will test the central hypothesis that organ sharing over broader geographies would result in better allocation of organs as measured by:
References
- higher rates of organ allocation to higher priority candidates and
- improved survival on the waiting list among lung transplant candidates.
References
- Russo MJ, Hong KN, Iribarne A, Gelijns A, Sonett JR. (2011). Does Lung Allocation Score predict net benefit from lung transplantation. J Thorac Cardiovasc Surg. 141:1270-78.
- Iribarne A, Russo MJ, Davies RR, et. al. (2009). Despite Decreased Wait-List Times for Lung Transplantation, Lung Allocation Scores Continue to Increase; Chest 135; 923-928.
- Distribution of Donor Lungs in the United States: A Case for Broader Geographic Sharing. Under review.
- The Local Allocation of Donor Lungs Results in Transplanting Lower Priority Lung Transplant Candidates. 2012 Annual Society of Thoracic Surgeons Meeting, Ft Laudredale, FL.
Measuring Clinical and Outcomes and Cost in Cardiac Surgery
In the current healthcare environment, there is increasing pressure to improve outcomes while containing costs. In fact, quality measures will influence how healthcare services are reimbursed in the future. In 2007, the Centers for Medicaid and Medicare Services (CMS) determined that it would no longer pay for “preventable” complications. These never events include, among others, retained foreign bodies, mediastinitis after CABG, line infections, pressure ulcers, and air embolism. In 2011, CMS issued the Hospital Inpatient Value-Based Purchasing program final rule. Under this program, CMS will provide higher payments to hospitals that perform well on certain quality measures relating to both clinical process and patient experience of care. This initiative is intended to help reduce health care costs and reward hospitals for the quality of care they provide to Medicare beneficiaries. This program will apply to hospital discharges occurring on or after October 1, 2012, with payments based on whether a hospital meets or exceeds performance standards. Defined changes in payer strategies such as these further highlight the need to better understand processes of care and how to improve them.
While instituting standardized process-of-care measures requires a significant institutional commitment, the long-term benefits with regard to clinical outcomes and resource utilization cannot be underestimated. In addition, with new policy measures such as the Hospital Inpatient Value-Based Purchasing initiative, hospitals will be placed under significant pressure to avoid such adverse events. For example, pneumonia and sepsis represent infectious complications that may benefit from increased efforts at standardization of institutional process-of-care measures to reduce potentially preventable complications. While complications have a significant and multiplicative effect on resource utilization for the index hospitalization, the effect of complications also influences long-term costs based on increased need for skills nursing and intermediate care placement upon discharge, as well as lost work productivity.
We are exploring analysis to better understand the relationships between preoperative patient characteristics, complications, center/provider characteristics, and outcomes. This information may help drive quality improvement initiatives as well as improve cost-effectiveness and ultimately improve patient outcomes.
References
While instituting standardized process-of-care measures requires a significant institutional commitment, the long-term benefits with regard to clinical outcomes and resource utilization cannot be underestimated. In addition, with new policy measures such as the Hospital Inpatient Value-Based Purchasing initiative, hospitals will be placed under significant pressure to avoid such adverse events. For example, pneumonia and sepsis represent infectious complications that may benefit from increased efforts at standardization of institutional process-of-care measures to reduce potentially preventable complications. While complications have a significant and multiplicative effect on resource utilization for the index hospitalization, the effect of complications also influences long-term costs based on increased need for skills nursing and intermediate care placement upon discharge, as well as lost work productivity.
We are exploring analysis to better understand the relationships between preoperative patient characteristics, complications, center/provider characteristics, and outcomes. This information may help drive quality improvement initiatives as well as improve cost-effectiveness and ultimately improve patient outcomes.
References
- Iribarne A, Burgener J, Raman J, Akhtar S, Easterwood R, Jeevanandam V, Russo MJ. Quantifying the Incremental Cost of Complications Associated with Mitral Valve Surgery in the United States. 2011 Annual Meeting of the Western Thoracic Surgical Association, Colorado Springs, CO.
- Resource Utilization After Thoracic Aortic Aneurysm Repair: A Comparison of Open versus Endovascular Approaches in the United States. 2012 Annual Society of Thoracic Surgeons Meeting, Ft Laudredale, FL.
[Clinical and economic outcomes in Aortic Dissections]
[Risk Stratification in Cardiac Surgery and Transplantation]
[The Clinical and Economic Evaluation of Devices/VADs]
[Risk Stratification in Cardiac Surgery and Transplantation]
[The Clinical and Economic Evaluation of Devices/VADs]