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Kidney offer acceptance at programs undergoing a Systems Improvement Agreement
Author(s) -
Bowring Mary G.,
Massie Allan B.,
CraigSchapiro Rebecca,
Segev Dorry L.,
Nicholas Lauren Hersch
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14907
Subject(s) - medicine , medicaid , kidney transplant , kidney transplantation , kidney , urology , health care , economics , economic growth
In the United States, the Centers for Medicare and Medicaid Services ( CMS ) use Systems Improvement Agreements ( SIA s) to require transplant programs repeatedly flagged for poor‐performance to improve performance or lose CMS funding for transplants. We identified 14 kidney transplant ( KT ) programs with SIA s and 28 KT programs without SIA s matched on waitlist volume and characterized kidney acceptance using SRTR data from 12/2006‐3/2015. We used difference‐in‐differences linear regression models to identify changes in acceptance associated with an SIA independent of program variation and trends prior to the SIA . SIA programs accepted 26.9% and 22.1% of offers pre‐ and post‐ SIA , while non‐ SIA programs accepted 33.9% and 44.4% of offers in matched time periods. After adjustment for donor characteristics, time‐varying waitlist volume, and secular trends, SIA s were associated with a 5.9 percentage‐point (22%) decrease in kidney acceptance (95% CI : −10.9 to −0.8, P = .03). The decrease in acceptance post‐ SIA was more pronounced for KDPI 0‐40 kidneys (12.3 percentage‐point decrease, P = .007); reductions in acceptance of higher KDPI kidneys occurred pre‐ SIA . Programs undergoing SIA s substantially reduced acceptance of kidney offers for waitlisted candidates. Attempts to improve posttransplant outcomes might have the unintended consequence of reducing access to transplantation as programs adopt more restrictive organ selection practices.