Changing Metrics of Organ Procurement Organization Performance in Order to Increase Organ Donation Rates in the United States.

The shortage of deceased-donor organs is compounded by donation metrics that fail to account for the total pool of possible donors, leading to ambiguous donor statistics. We sought to assess potential metrics of organ procurement organizations (OPOs) utilizing data from the Nationwide Inpatient Sample (NIS) from 2009-2012 and State Inpatient Databases (SIDs) from 2008-2014. A possible donor was defined as a ventilated inpatient death ≤75 years of age, without multi-organ system failure, sepsis, or cancer, whose cause of death was consistent with organ donation. These estimates were compared to patient-level data from chart review from two large OPOs. Among 2,907,658 inpatient deaths from 2009-2012, 96,028 (3.3%) were a "possible deceased-organ donor." The two proposed metrics of OPO performance were: (1) donation percentage (percentage of possible deceased-donors who become actual donors; range: 20.0-57.0%); and (2) organs transplanted per possible donor (range: 0.52-1.74). These metrics allow for comparisons of OPO performance and geographic-level donation rates, and identify areas in greatest need of interventions to improve donation rates. We demonstrate that administrative data can be used to identify possible deceased donors in the US and could be a data source for CMS to implement new OPO performance metrics in a standardized fashion.

The National Disaster Medical System: a concept in large-scale emergency medical care.

The national disaster medical system is a new program established in 1981 to develop and implement a national policy to improve emergency preparedness for large-scale disasters. This article describes the background and purpose of this activity and delineates the elements of the system, which include a rapid medical response, patient evacuation, and definitive medical care. The program is designed to involve resources at the federal, state, and community levels. This article describes how local communities may participate in this initiative.

Training health professionals in the care of the elderly.

Twenty-seven projects for the development of interdisciplinary geriatric curricula were supported by the Health Resources Administration's Bureau of Health Professions in fiscal 1979. A variety of clinical training sites were used (e.g., university gerontology centers, VA medical centers, senior citizen facilities, adult health care centers), and innovative teaching approaches were developed. For example, a combined medical/dental/optometry clinic is conducted by students at the three professional schools; medical students accompany volunteers serving Meals on Wheels; and dental students treat patients in nursing homes in a mobile dental unit. Students have gained insights into the problems of the elderly and the roles of other health professionals through the interdisciplinary-team training courses. Nurse-practitioner programs to prepare nurses to provide primary health care to the elderly were also supported by the Bureau, as were special projects to develop short-term in-service basic training programs for nurses' aides and orderlies in nursing homes, to upgrade the skills of the paraprofessionals who care for the elderly. In other projects, the geriatric educational needs of pharmacy students were assessed, and dental schools promoted remote-site training to improve access to dental care for the elderly.

Federal-state synergy in family medicine education.

During the 1960s national policy groups assessed the consequences of a four-decade decline in the nation's number of general practitioners. Various proposals were offered to make general practice a more attractive specialty. Most of the proposals have been institutionalized by means of a family practice specialty board, accredited family practice residency programs, and academic family practice units in medical schools. In retrospect, two events can be identified as critical factors in the successful launching of the family practice specialty: (1) the merging of the movement to make real the theoretical, normative concept of the primary care physician proposed in the academic literature with a reform movement within the clinically based, politically astute American Academy of General Practice and (2) the establishment of extramural funds for family practice, which helped it gain a crucial foothold within academic medical centers. The broad themes of the family practice movement, established in the 1960s and 1970s, continue to be appropriate themes for the 1980s and 1990s.