Evaluating center performance in the competing risks setting: Application to outcomes of wait‐listed end‐stage renal disease patients

Evaluating center performance in the competing risks setting: Application to outcomes of... IntroductionThe availability of electronic health records and the demand for value‐driven healthcare have led to greatly increased interest in the methods for evaluation of center performance (Ash et al., ). For continuous or binary outcomes, center effects are usually estimated as either fixed or random effects models. Evaluation of center performance is then generally carried out by comparing these estimated risk‐adjusted center effects to some fixed quantity, or the average center effect, or by using graphical checks (Spiegelhalter et al., ).The proposed methods are motivated by the end‐stage renal disease (ESRD) setting. There are thousands more patients in need of transplantation than there are donor kidneys. As a result, medically suitable ESRD patients are placed on a waiting list. For example, in 2015, there were 98,956 patients on the kidney waiting list at year‐end, but only 11,594 deceased‐donor kidney transplants (Hart et al., ). In the United States, there are 58 wait‐lists, each administered by an Organ Procurement Organization (OPO). Our objective here is to evaluate OPOs with respect to (i) kidney transplantation and (ii) pre‐transplant death (competing risks) among wait‐listed patients.While there has been extensive research conducted into establishing methods for institutional comparisons with respect to binary and http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Biometrics Wiley

Evaluating center performance in the competing risks setting: Application to outcomes of wait‐listed end‐stage renal disease patients

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018, The International Biometric Society
ISSN
0006-341X
eISSN
1541-0420
D.O.I.
10.1111/biom.12739
Publisher site
See Article on Publisher Site

Abstract

IntroductionThe availability of electronic health records and the demand for value‐driven healthcare have led to greatly increased interest in the methods for evaluation of center performance (Ash et al., ). For continuous or binary outcomes, center effects are usually estimated as either fixed or random effects models. Evaluation of center performance is then generally carried out by comparing these estimated risk‐adjusted center effects to some fixed quantity, or the average center effect, or by using graphical checks (Spiegelhalter et al., ).The proposed methods are motivated by the end‐stage renal disease (ESRD) setting. There are thousands more patients in need of transplantation than there are donor kidneys. As a result, medically suitable ESRD patients are placed on a waiting list. For example, in 2015, there were 98,956 patients on the kidney waiting list at year‐end, but only 11,594 deceased‐donor kidney transplants (Hart et al., ). In the United States, there are 58 wait‐lists, each administered by an Organ Procurement Organization (OPO). Our objective here is to evaluate OPOs with respect to (i) kidney transplantation and (ii) pre‐transplant death (competing risks) among wait‐listed patients.While there has been extensive research conducted into establishing methods for institutional comparisons with respect to binary and

Journal

BiometricsWiley

Published: Jan 1, 2018

Keywords: ; ; ; ; ;

References

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