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      Quality metrics in solid organ transplantation: protocol for a systematic scoping review

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          Transplantation is often the best, if not the only treatment for end-stage organ failure; however, the quality metrics for determining whether a transplant program is delivering safe, high quality care remains unknown. The purpose of this study is to identify and describe quality indicators or metrics in patients who have received a solid organ transplant.


          We will conduct a systematic scoping review to evaluate and describe quality indicators or metrics in patients who have received a solid organ transplant. We will search MEDLINE, Embase, and the Cochrane Central Register for Controlled Trials. Two reviewers will conduct all screening and data extraction independently. The articles will be categorized according to the six domains of quality, and the metrics will be appraised using criteria for a good quality measure.


          The results of this review will guide the development, selection, and validation of appropriate quality metrics necessary to drive quality improvement in transplantation.

          Systematic review registration

          PROSPERO CRD42016035353.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13643-016-0279-4) contains supplementary material, which is available to authorized users.

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          Most cited references 12

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

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            The quality of care. How can it be assessed?

             A Donabedian (2015)
            Before assessment can begin we must decide how quality is to be defined and that depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system; on how broadly health and responsibility for health are defined; on whether the maximally effective or optimally effective care is sought; and on whether individual or social preferences define the optimum. We also need detailed information about the causal linkages among the structural attributes of the settings in which care occurs, the processes of care, and the outcomes of care. Specifying the components or outcomes of care to be sampled, formulating the appropriate criteria and standards, and obtaining the necessary information are the steps that follow. Though we know much about assessing quality, much remains to be known.
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              A study of the quality of life and cost-utility of renal transplantation.

              The objective of this study was to assess the cost-utility of renal transplantation compared with dialysis. To accomplish this, a prospective cohort of pre-transplant patients were followed for up to two years after renal transplantation at three University-based Canadian hospitals. A total of 168 patients were followed for an average of 19.5 months after transplantation. Health-related quality of life was assessed using a hemodialysis questionnaire, a transplant questionnaire, the Sickness Impact Profile, and the Time Trade-Off Technique. Fully allocated costs were determined by prospectively recording resource use in all patients. A societal perspective was taken. By six months after transplantation, the mean health-related quality of life scores of almost all measures had improved compared to pre-transplantation, and they stayed improved throughout the two years of follow up. The mean time trade-off score was 0.57 pre-transplant and 0.70 two years after transplantation. The proportion of individuals employed increased from 30% before transplantation to 45% two years after transplantation. Employment prior to transplantation [relative risk (RR) = 23], graft function (RR 10) and age (RR 1.6 for every decrease in age by one decade), independently predicted employment status after transplantation. The cost of pre-transplant care ($66,782 Can 1994) and the cost of the first year after transplantation ($66,290) were similar. Transplantation was considerably less expensive during the second year after transplantation ($27,875). Over the two years, transplantation was both more effective and less costly than dialysis. This was true for all subgroups of patients examined, including patients older than 60 and diabetics. We conclude that renal transplantation was more effective and less costly than dialysis in all subgroups of patients examined.

                Author and article information

                613-738-8400 ,
                Syst Rev
                Syst Rev
                Systematic Reviews
                BioMed Central (London )
                14 June 2016
                14 June 2016
                : 5
                [ ]Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, K1H 7W9 Ontario Canada
                [ ]Department of Medicine, University of Ottawa, Ottawa, Ontario Canada
                [ ]Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Canada
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef, Canadian Institutes of Health Research;
                Award ID: 143239
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                © The Author(s) 2016

                Public health

                health indicators, quality, solid organ transplantation


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