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

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Abstract

Background

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.

Methods/design

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.

Discussion

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 9

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A study of the quality of life and cost-utility of renal transplantation.

Andreas Laupacis, Paul Keown, Nancy Pus … (1996)

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.

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Crossing the Quality Chasm: A New Health System for the 21st Century

LT Kohn, JM Corrigan, MS Donaldson … (2001)

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Comparative Survival and Economic Benefits of Deceased Donor Kidney Transplantation and Dialysis in People with Varying Ages and Co-Morbidities

Germaine Wong, Kirsten Howard, Jeremy R Chapman … (2012)

Background Deceased donor kidneys for transplantation are in most countries allocated preferentially to recipients who have limited co-morbidities. Little is known about the incremental health and economic gain from transplanting those with co-morbidities compared to remaining on dialysis. The aim of our study is to estimate the average and incremental survival benefits and health care costs of listing and transplantation compared to dialysis among individuals with varying co-morbidities. Methods A probabilistic Markov model was constructed, using current outcomes for patients with defined co-morbidities treated with either dialysis or transplantation, to compare the health and economic benefits of listing and transplantation with dialysis. Findings Using the current waiting time for deceased donor transplantation, transplanting a potential recipient, with or without co-morbidities achieves survival gains of between 6 months and more than three life years compared to remaining on dialysis, with an average incremental cost-effectiveness ratio (ICER) of less than $50,000/LYS, even among those with advanced age. Age at listing and the waiting time for transplantation are the most influential variables within the model. If there were an unlimited supply of organs and no waiting time, transplanting the younger and healthier individuals saves the most number of life years and is cost-saving, whereas transplanting the middle-age to older patients still achieves substantial incremental gains in life expectancy compared to being on dialysis. Conclusions Our modelled analyses suggest transplanting the younger and healthier individuals with end-stage kidney disease maximises survival gains and saves money. Listing and transplanting those with considerable co-morbidities is also cost-effective and achieves substantial survival gains compared with the dialysis alternative. Preferentially excluding the older and sicker individuals cannot be justified on utilitarian grounds.

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Author and article information

Contributors

Greg A. Knoll: 613-738-8400 , gknoll@ottawahospital.on.ca

Journal

Journal ID (nlm-ta): Syst Rev

Journal ID (iso-abbrev): Syst Rev

Title: Systematic Reviews

Publisher: BioMed Central (London )

ISSN (Electronic): 2046-4053

Publication date (Electronic): 14 June 2016

Publication date PMC-release: 14 June 2016

Publication date Collection: 2016

Volume: 5

Electronic Location Identifier: 99

Affiliations

[ ]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

Article

Publisher ID: 279

DOI: 10.1186/s13643-016-0279-4

PMC ID: 4908804

PubMed ID: 27301969

SO-VID: ee1959b5-d2a8-4b60-b0eb-149d07cc99af

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), 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 ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 22 February 2016

Date accepted : 1 June 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;

Award ID: 143239

Award Recipient : Greg A. Knoll

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ScienceOpen disciplines: Public health

Keywords: solid organ transplantation,quality,health indicators

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ScienceOpen disciplines: Public health

Keywords: solid organ transplantation, quality, health indicators

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

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Systematic review registration

Electronic supplementary material

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Most cited references 9

A study of the quality of life and cost-utility of renal transplantation.

Crossing the Quality Chasm: A New Health System for the 21st Century

Comparative Survival and Economic Benefits of Deceased Donor Kidney Transplantation and Dialysis in People with Varying Ages and Co-Morbidities

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