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Improving The Peri -Operative Value Of Care For Kidney Transplant Recipients

Improving The Peri -Operative Value Of Care For Kidney Transplant Recipients. David Taber, Charles Bratton, Angello Lin, John McGillicuddy, Kenneth Chavin and Prabhakar Baliga. OUTLINE. Define Health Care Value Health Care Value in Kidney Transplant Current and future challenges

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Improving The Peri -Operative Value Of Care For Kidney Transplant Recipients

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  1. Improving The Peri-Operative Value Of Care For Kidney Transplant Recipients David Taber, Charles Bratton, Angello Lin, John McGillicuddy, Kenneth Chavin and Prabhakar Baliga

  2. OUTLINE • Define Health Care Value • Health Care Value in Kidney Transplant • Current and future challenges • Study Design • Study Results • Discussion and Conclusions

  3. Defining Health Care Value (TRUE OUTCOMES per care cycle) RESULTS OF CARE ÷ COST (TOTAL OF ALL SERVICES to provide care during this cycle) NEJM 2010; 363:2477-81.

  4. Measuring Health Care Value in Kidney Txp • COSTS • OUTCOMES • Organ Acquisition • Surgery • Medication • Accommodations • Imaging • Laboratory • PT/OT • Clinic Visits • Outpatient Procedures • Additional Ancillary • Patient and Graft Survival • 1, 3, 5, 10 year • Graft Function (GFR) • 1, 3, 5, 10 year • Acute Rejection • 3, 6, 12 month • Infections • 6, 12, >12 month • Peri-Operative • Urine leak, wound infection, hernia, NODAT, HTN, acute MI, etc… • Indicators: LOS & Readmissions

  5. Challenges with Kidney Transplantation Increased use of marginal donors

  6. Challenges with Kidney Transplantation KDRI ≥ 1.45 = 60% GS at 5 years KDRI 0.8 = 80% GS at 5 years Higher risk donors (KDRI)

  7. Challenges with Kidney Transplantation Older Recipients

  8. Challenges with Kidney Transplantation More Comorbidities

  9. Challenges with Kidney Transplantation AJT 2008;8(3):586-92.

  10. Current Challenge with Transplantation Use of marginal donors and high-risk recipients has led to more complex post-operative management Stagnate or shrinking reimbursement rates Shrinking or negative net margins Future risks associated with lack of payment for readmissions

  11. Methods • Retrospective cross-sectional analysis • Utilized both UHC and SRTR data • Compare outcomes at our center, benchmarked to national data • Before, during and after quality initiatives implemented • Outcomes measured • LOS, readmissions, in-hospital complications, costs

  12. Initiatives STRUCTURE PROCESS • Daily Rounds with Nephrologist • Early dialysis for anuric/rising SrCr • POD 2 – review need for dialysis, reserve chair for 7 AM • Coordinate with need for medications with long infusions (rATG, IVIG) • Daily clinic visits with nephrologist • Revised DGF Protocols • Discharge on POD 3 with daily clinic follow up by nephrologist • Early referral back to home dialysis chair • Protocol biopsies

  13. Outcomes

  14. DGF Rates All Other Txp Centers MUSC

  15. Length of Stay All Other Txp Centers All Other Txp Centers MUSC MUSC ALL PATIENTS DGF PATIENTS

  16. 30-Day Readmissions All Other Txp Centers All Other Txp Centers MUSC MUSC ALL PATIENTS DGF PATIENTS

  17. In-Hospital Mortality All Other Txp Centers All Other Txp Centers MUSC MUSC ALL PATIENTS DGF PATIENTS

  18. Direct Costs All Other Txp Centers All Other Txp Centers MUSC MUSC ALL PATIENTS DGF PATIENTS

  19. Conclusions • Healthcare value can be significantly improved in kidney transplant recipients by implementing initiatives aimed at improving both the process and structure of how care is provided

  20. Future Directions and Collaborations Partner with other surgery types to demonstrate applicability and scalability Develop and submit prospective study in other organ transplant types Develop initiatives to reduce long-term readmissions

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