Don't Throw Your Heart Away: Increased Transparency of Donor Utilization Practices in Transplant Center Report Cards Alters How Center Performance Is Evaluated.
Don't Throw Your Heart Away: Increased Transparency of Donor Utilization Practices in Transplant Center Report Cards Alters How Center Performance Is Evaluated.
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DOI：
10.1177/0272989x211038941
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发表时间：
2022-04
期刊：
影响因子：
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通讯作者：
Chapman GB
中科院分区：
文献类型：
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作者：
Butler AE;Chapman GB
移植中心的公开成绩单强调移植后的存活，掩盖了这样一个事实，即一些中心拒绝接受他们提供的许多捐赠器官(反映了保守的捐赠者接受策略)，而另一些中心则接受了范围更广的捐赠者提供(反映了开放的捐赠者接受策略)。我们评估了关于捐献者接受做法和等待名单存活率的显著信息的提供如何影响非专业人员和医学实习生对医院成绩单的评估判断。我们通过四个在线随机实验(n1=1003，n2=105，n3=123，n4=807)在相同的假设决定中测试了五种不同的报告卡格式。主要结果变量是移植医院之间的二元选择(一个采用开放的供者接受策略，另一个采用保守的供者接受策略)。以供体器官利用率(根据接受的供体提供的质量分类的移植结果)或总体存活率(来自等待名单和移植患者的结果)的显著信息的报告卡，导致非专业参与者(研究1、3和4)和医学实习生(研究2)评估采用开放供体接受策略的移植中心比采用保守策略的中心更有利。由于该决定的性质，出于道德和实际原因，假设的情况是必要的。结果可能不适用于移植临床医生或面临在哪里加入移植等待名单的决定的患者。这些发现表明，移植中心的绩效评估可能会有很大的差异，不仅取决于报告卡中呈现的结果信息，而且还取决于信息的显示方式。
Publicly available report cards for transplant centers emphasize post-transplant survival and obscure the fact that some centers reject many of the donor organs they are offered (reflecting a conservative donor acceptance strategy), while others accept a broader range of donor offers (reflecting an open donor acceptance strategy). We assessed how the provision of salient information about donor acceptance practices and waitlist survival rates impacted evaluation judgments of hospital report cards given by lay people and medical trainees. We tested five different report card formats across four online randomized experiments (n1=1003, n2=105, n3=123, n4=807) in the same hypothetical decision. The primary outcome variable was a binary choice between transplant hospitals (one with an open donor acceptance strategy and the other with a conservative donor acceptance strategy). Report cards featuring salient information about donor organ utilization rates (transplant outcomes categorized by quality of donor offers accepted), or overall survival rates (outcomes from both waitlist and transplanted patients) led lay participants (Studies 1, 3, and 4) and medical trainees (Study 2) to evaluate transplant centers with open donor acceptance strategies more favorably than centers with conservative strategies. Due to the nature of the decision, a hypothetical scenario was necessary for both ethical and practical reasons. Results may not generalize to transplant clinicians or patients faced with the decision of where to join the transplant waitlist. These findings suggest that performance evaluations for transplant centers may vary significantly based not only on what outcome information is presented in report cards, but also how the information is displayed.