Quality Metrics in Solid Organ Transplantation: A Systematic Review

Abstract

Background: The best approach for determining whether a transplant program is delivering high-quality care is unknown. This review aims to identify and characterize quality metrics in solid organ transplantation.

Methods: Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from inception until February 1, 2017. Relevant full text reports and conference abstracts that examined quality metrics in organ transplantation were included. Two reviewers independently extracted study characteristics and quality metrics from 52 full text reports and 24 abstracts. PROSPERO registration: CRD42016035353.

Results: Three hundred seventeen quality metrics were identified and condensed into 114 unique indicators with sufficient detail to be measured in practice; however, many lacked details on development and selection, were poorly defined, or had inconsistent definitions. The process for selecting quality indicators was described in only 5 publications and patient involvement was noted in only 1. Twenty-four reports used the indicators in clinical care, including 12 quality improvement studies. Only 14 quality metrics were assessed against patient and graft survivals.

Conclusions: More than 300 quality metrics have been reported in transplantation but many lacked details on development and selection, were poorly defined, or had inconsistent definitions. Measures have focused on safety and effectiveness with very few addressing other quality domains, such as equity and patient-centeredness. Future research will need to focus on transparent and objective metric development with proper testing, evaluation, and implementation in practice. Patients will need to be involved to ensure that transplantation quality metrics measure what is important to them.

FIGURE 1.

Frequency of quality metric reporting. Each of these metrics was noted in at least four unique publications. OR, operating room.

FIGURE 2.

Reporting of quality metrics by type and period of care (n=114).

FIGURE 3.

Reporting of quality metrics by domain of quality. A, Overall frequency of the domains of quality (n=114). B, Reporting of quality metrics by domain and period of care (n=114).

FIGURE 4.

Individual quality metrics grouped by domain of quality and mapped against the different organ types where the metrics could be applied. Only the kidney, liver, and heart had organ-specific metrics (ie, metrics that could not be applied to other organs). O/E, observed to expected; ICU, intensive care unit; LOS, length of stay; MELD, Model for End-Stage Liver Disease.