دورية أكاديمية
أعرض في EDS

Accuracy of risk models used for public reporting of heart transplant center performance.

التفاصيل البيبلوغرافية
العنوان: Accuracy of risk models used for public reporting of heart transplant center performance.
المؤلفون: Dolgner SJ; Adult Congenital Heart Program, Texas Children's Hospital, Houston, Texas, USA., Nguyen VP; Providence Heart Institute, Providence St. Vincent's Medical Center, Portland, Oregon, USA., Cowger J; Division of Cardiovascular Medicine, Henry Ford Hospitals, Detroit, Michigan, USA., Dardas TF; Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA.
المصدر: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2021 Dec; Vol. 40 (12), pp. 1571-1578. Date of Electronic Publication: 2021 Aug 06.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 9102703 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-3117 (Electronic) Linking ISSN: 10532498 NLM ISO Abbreviation: J Heart Lung Transplant Subsets: MEDLINE
أسماء مطبوعة: Publication: 1999- : New York, NY : Elsevier
Original Publication: St. Louis, Mo. : Mosby-Year Book, Inc., c1991-
مواضيع طبية MeSH: Graft Survival* , Registries*, Graft Rejection/*epidemiology , Heart Transplantation/*statistics & numerical data , Quality Indicators, Health Care/*statistics & numerical data , Tissue and Organ Procurement/*statistics & numerical data, Female ; Heart Transplantation/adverse effects ; Humans ; Male ; Middle Aged ; Models, Statistical ; Reproducibility of Results ; Risk Assessment
مستخلص: Background: Heart transplant programs and regulatory entities require highly accurate performance metrics to support internal quality improvement activities and national oversight of transplant programs, respectively. We assessed the accuracy of publicly reported performance measures.
Methods: We used the United Network for Organ Sharing registry to study patients who underwent heart transplantation between January 1, 2016 and June 30, 2018. We used tests of calibration to compare the observed rate of 1-year graft failure to the expected risk of 1-year graft failure, which was calculated for each recipient using the July 2019 method published by the Scientific Registry of Transplant Recipients (SRTR). The primary study outcome was the joint test of calibration, which accounts for both the total number of events predicted (calibration-in-the-large) and dispersion of risk predictions (calibration slope).
Results: 6,528 heart transplants were analyzed. The primary test of calibration failed (p <0.0001), indicating poor accuracy of the SRTR model. The calibration-in-the-large statistic (0.63, 95% confidence interval [CI] 0.58-0.68, p < 0.0001) demonstrated overestimation of event rates while the calibration slope statistic (0.56, 95% CI 0.49-0.62, p <0.0001) indicated over-dispersion of event rates. Pre-specified subgroup analyses demonstrated poor calibration for all subgroups (each p <0.01). After recalibration, program-level observed/expected ratios increased by a median of 0.14 (p <0.0001).
Conclusions: Risk models employed for publicly-reported graft survival at U.S. heart transplant centers lack accuracy in general and in all subgroups tested. The use of disease-specific models may improve the accuracy of program performance metrics.
(Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
فهرسة مساهمة: Keywords: heart transplant; model calibration; risk model
تواريخ الأحداث: Date Created: 20210901 Date Completed: 20220221 Latest Revision: 20220221
رمز التحديث: 20240628
DOI: 10.1016/j.healun.2021.07.027
PMID: 34465530
قاعدة البيانات: MEDLINE
الوصف
تدمد:1557-3117
DOI:10.1016/j.healun.2021.07.027