US News & World Report rankings may have no relevance to clinical outcomes of renal transplant programs.
New Orleans-For patients in need of a renal transplant, a popular magazine’s rankings of hospital nephrology departments should be viewed cautiously as they may have no relevance to clinical outcomes of the renal transplant program, a group of transplant surgeons reported at the AUA annual meeting in New Orleans.
Their study investigated associations between patient and graft survival rates at month 1, year 1, and year 3 derived from the Scientific Registry of Transplant Recipients (SRTR) Database and rankings of hospital nephrology departments generated by US News & World Report hospital rankings. The transplant outcomes data were derived for 231 hospitals with active renal transplant programs in the year 2011. Rankings of nephrology departments were chosen as surrogates for the hospitals’ transplant programs, which are not ranked by US News & World Report.
The analyses showed that the majority of hospitals that did not make the publication’s top 50 list had patient and graft survival rates that were higher than expected, according to the risk-adjusted model used by the SRTR to assess hospital performance. However, 40% of the 50 institutions included in the periodical’s top 50 list had renal transplant programs with lower than expected patient and graft survival rates, said senior author Jorge Ortiz, MD, associate professor of surgery, The University of Toledo, Toledo, OH.
“Lay ratings of physician and institution performance are becoming increasingly prevalent, but these systems may not adequately take into account the complexities affecting outcomes in health care delivery,” said Dr. Ortiz.
“Urologists or other physicians who are discussing transplant with their renal failure patients should not just base their selection of an institution for the procedure on a single rating. Instead, they need to consider the multitude of objective and subjective factors that may influence quality outcomes.”
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Logistic regression analysis was also performed to determine whether each of several parameters used to determine the magazine rankings (volume, in-house intensive care unit intensivist, modern technology, and “would a specialist recommend their institution”) correlated with the various transplant outcomes. Among the multiple analyses that were conducted, only three statistically significant correlations were found. Specifically, the variable of “would a specialist recommend their institution” was associated with increased odds of good graft survival at 1 year and having an in-house ICU intensivist and modern technology were predictors of a good 3-year graft survival rate.
“Not only did very few variables correlate with any of the objective outcomes, but there were no consistent associations for those that did, or any simple explanation for their predictive value,” Dr. Ortiz said.
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