Public reports do not improve care for transplant patients

When transplant clinics must publicly report their success rates, this should provide an incentive to improve care for patients. But a recent study appearing in the Clinical Journal of the American Society Nephrology (CJASN) found that such public reporting has not had any effect on the care that transplant patients receive.

Public reports of the successes and failures of clinics can help patients choose where they want to receive medical care. Reports can also help the clinics themselves correct their shortcomings to improve the care they provide. But such reports are only useful if they contain accurate information.

Constantia Petrou, PhD (Culmini Inc.), Stefanos Zenios, PhD (Culmini Inc. and Stanford University) and their colleagues compared the accuracy of two methods that can be used in public reporting of transplant centers. They found that the current method that is widely used is less accurate than a new method (called a generalized mixed effect method) that can provide a more realistic assessment of differences across centers. Using and improving this new method and communicating its results to kidney specialists who recommend transplant centers to their patients could strengthen the effectiveness of public reports.

The new method revealed that the gaps between the best and worst clinics did not diminish after public reporting was introduced in 2001. The authors advocate for additional studies to investigate why public reports have not reduced differences across transplant centers. "If public reports did become effective and each center's outcomes matched those of the center with the best outcomes, 29% of deaths and 33% of organ failures could be averted," said Dr. Petrou. "Missing such potential improvements is like having one Boeing 747 with transplant recipients crash every year," she explained.