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Multicultural Webcast September 16, 2014 2:00 – 4:00 pm ET

Multicultural Webcast September 16, 2014 2:00 – 4:00 pm ET. Planning Committee Members. Glenn M. Matsuki – Co-Chair Process Improvement Project Manager, California Transplant Donor Network Bobby Howard, MDEP – Co-Chair

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Multicultural Webcast September 16, 2014 2:00 – 4:00 pm ET

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  1. Multicultural WebcastSeptember 16, 20142:00 – 4:00 pm ET

  2. Planning Committee Members • Glenn M. Matsuki – Co-Chair Process Improvement Project Manager, California Transplant Donor Network • Bobby Howard, MDEP – Co-Chair President, AMAT, Director, Multicultural Donation Education, LifeLink of Georgia • LeAnn Swanson, MPH Executive Director, Organ Donation and Transplantation Alliance • Teresa Beigay, DrPH Director of Special Donation Initiatives, HHS/HRSA/HSB/Division of Transplantation • Roxane Cauwels, BSN, MBA DTCP Consultant, Organ Donation and Transplantation Alliance

  3. Presenters • Glenn M. Matsuki Process Improvement Project Manager, CTDN • Bobby Howard, MDEP President, AMAT, Director, Multicultural Donation Education, LifeLink of Georgia • Bob Carrico, PhD Senior Biostatistician, United Network for Organ Sharing • Debbi McRann, RN, BSN, CTPC Director, Clinical Services, The Living Legacy Foundation of Maryland • Marion L. Shuck Manager, Community Affairs, Gift of Hope Organ & Tissue Donor Network

  4. Objectives • Share strategies to analyze data on various cultures to help develop educational strategies to different multicultural groups • Show how geo-mapping is used to target education and ways to integrate into practice • Provide a forum for learning about foundational tools to improve cultural competency

  5. What is Our Current Multicultural Reality? Bob Carrico, PhD Sr. Biostatistician – Bob.Carrico@UNOS.org United Network for Organ Sharing Richmond, VA

  6. Number of Donors 2010 - 2013

  7. Introduction / Outline • Can we find standout OPOs using current national DSA level data? • Metric: Authorization Rate • Authorization of Eligible Deaths – Percent by OPO. • By ethnicities: White, Black, Hispanic, Asian • Can we find statistical significance? • Where does this leave us?

  8. Authorization Rate 2010 - 2013

  9. Study Purpose • Use data to show OPOs that are top performers • Want to find factors that influence this • Data • Geography and Population • Philosophies, Procedures, Techniques • How can OPOs look at data to study trends • How can this influence practice?

  10. Authorization Distribution: White

  11. Authorization Distribution: Black

  12. Authorization Distribution: Hispanic

  13. Authorization Distribution: Asian

  14. Authorization Distribution: All

  15. Ethnicity Comparison: Approach • Logistic Regression: Odds Ratios • Probability of an event = Y (where 0 < Y < 1) Odds of same event = Y / (1-Y) • Example • Authorization Rate for Group A: 80%  Odds of Authorization are 4.00 = .8/.2 • Authorization Rate for Group B: 40%  Odds of Authorization are 0.67 = .4/.6 • Odds Ratio of A versus B  (4.00) / (0.67) = 6.00 • “The odds of authorization for group A are 6 times higher than the odds for group B” • Odds Ratios Adjusted for age; gender; cause, mechanism, and circumstance of death. • Using Hierarchical Generalized Linear Model • Eligible deaths at each OPO are under similar circumstances

  16. Ethnicity Comparison: Result • Odds of Authorization: • White 4.3 times higher than Asian • White 3.1 times higher than Black • White 2.3 times higher than Hispanic • Significant OPO level variation (p<0.01) • Significant variation exists between ethnicities, how to inform best practices?

  17. Finding Top Performers Analysis Approach • Odds Ratio: • Odds of Authorization for Candidate OPOs • Define criteria for Candidate OPOs • Compare to adjusted average of other candidate OPOs and non-candidate OPOs • How to select OPOs to test when there are many • Which OPOs can be candidates? • Logistic Regression Models • Compute adjusted odds ratios • Are candidate OPOs more likely to authorize individuals of a given ethnicity? • Adjust for: • Age; Gender; Cause, Mechanism, and Circumstance of Death.

  18. Authorization By Eligible Deaths - White

  19. Authorization By Eligible Deaths - White OPO Mean Authorization Rate: 83.3%

  20. Authorization By Eligible Deaths - White 50th Percentile Eligible Deaths: 321.5 OPO Mean Authorization Rate: 83.3%

  21. Authorization By Eligible Deaths - White

  22. Candidate OPO Map - White

  23. Authorization By Eligible Deaths - White

  24. Top Performers: White Authorization • ILIP-OP1: Gift of Hope • Crude Authorization Rate: 90.4% • Adjusted OR (p-value): 1.48 (p<0.01) • Eligible Deaths 2010-2013: 591 • CORS-OP1: Donor Alliance • Crude Authorization Rate: 92.4% • Adjusted OR (p-value): 1.84 (p<0.01) • Eligible Deaths 2010-2013: 344 • WIUW-IO1: UW Health Organ and Tissue Donation • Crude Authorization Rate: 90.2% • Adjusted OR (p-value): 1.39 (p<0.05) • Eligible Deaths 2010-2013: 366

  25. Authorization By Eligible Deaths - Black

  26. Authorization By Eligible Deaths - Black OPO Mean Authorization Rate: 59.0%

  27. Authorization By Eligible Deaths - Black 50th Percentile Eligible Deaths: 93 OPO Mean Authorization Rate: 59.0%

  28. Authorization By Eligible Deaths - Black

  29. Candidate OPO Map - Black

  30. Authorization By Eligible Deaths - Black

  31. Top Performers: Black Authorization • LAOP-OP1: Louisiana Organ Procurement Agency • Crude Authorization Rate: 70.7% • Adjusted OR (p-value): 1.48 (p<0.01) • Eligible Deaths 2010-2013: 273 • TNMS-OP1: Mid-South Transplant Foundation • Crude Authorization Rate: 74.7% • Adjusted OR (p-value): 1.44 (p=0.04) • Eligible Deaths 2010-2013: 158 • ILIP-OP1: Gift of Hope • Crude Authorization Rate: 71.5% • Adjusted OR (p-value): 1.33 (p=0.01) • Eligible Deaths 2010-2013: 403

  32. Authorization By Eligible Deaths - Hispanic

  33. Authorization By Eligible Deaths - Hispanic OPO Mean Authorization Rate: 68.1%

  34. Authorization By Eligible Deaths - Hispanic 75th Percentile Eligible Deaths: 114 OPO Mean Authorization Rate: 68.1%

  35. Authorization By Eligible Deaths - Hispanic

  36. Candidate OPO Map - Hispanic

  37. Authorization By Eligible Deaths - Hispanic

  38. Top Performers: Hispanic Authorization • TXGC-OP1 – LifeGift Organ Donation Center • Crude Authorization Rate: 76.9% • Adjusted OR (p-value): 1.36 (p<0.01) • Eligible Deaths 2010-2013: 411

  39. Authorization By Eligible Deaths - Asian

  40. Authorization By Eligible Deaths - Asian OPO Mean Authorization Rate: 48.1%

  41. Authorization By Eligible Deaths - Asian 75th Percentile Eligible Deaths 28 OPO Mean Authorization Rate: 48.1%

  42. Authorization By Eligible Deaths - Asian

  43. Candidate OPO Map - Asian

  44. Authorization By Eligible Deaths - Asian

  45. Top Performers: Asian Authorization • ILIP-OP1: Gift of Hope • Crude Authorization Rate: 71.1% • Adjusted OR (p-value): 2.12 (p=0.03) • Eligible Deaths 2010-2013: 38

  46. Top Performer Maps

  47. Comparative Summary • Analysis Previously Studied for 1-year Rollback 4-year Cohort • Do OPOs vary in authorization rate annually?

  48. Ethnicity Longitudinal Trend

  49. White Ethnicity Longitudinal Trend Includes all OPOs meeting the sample size restriction for top performer analysis.

  50. Black Ethnicity Longitudinal Trend Includes all OPOs meeting the sample size restriction for top performer analysis.

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