Discrepancies in access and institutional risk tolerance in heart transplantation: A national open cohort study.
J Card Surg
; 34(10): 994-1003, 2019 Oct.
Article
en En
| MEDLINE
| ID: mdl-31374593
ABSTRACT
BACKGROUND:
The impact of center volume on heart transplantation is widely recognized and serves as a benchmark for certification and reimbursement. STUDYAIMS:
Study sociodemographic variables associated with access to high-volume centers and substantiate the importance of extending access to underserved populations.METHODS:
This study focused on adults undergoing heart transplantation between 2006 and 2015. Centers were clustered into terciles (>25, 14-25, or <14 transplants per year) and factors associated with receiving care in different terciles were identified through multinomial regression.RESULTS:
During the study period, 18 725 patients were transplanted at 145 centers. Younger age (<30 years) (P = .005), lower educational level (P < .001), and government-based insurance (P < .001) were associated to lower odds of receiving care at a high-volume center. These centers had higher risk recipients and accepted organs from higher risk donors, when compared to intermediate- and low-volume centers. Receiving care at high (odds ratio [OR], 1.212; P = .017) and intermediate-volume centers (OR, 1.304; P = .001) was associated with greater odds of 1-year survival when compared with low-volume centers.CONCLUSION:
Social, demographic, and geographic factors affect access to high- and intermediate-volume centers. High-volume centers tolerate more risk while providing excellent survival. Awareness of this impact should prompt an extension of access to care for underserved patient populations.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Donantes de Tejidos
/
Sistema de Registros
/
Vigilancia de la Población
/
Trasplante de Corazón
/
Medición de Riesgo
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Límite:
Female
/
Humans
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Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Card Surg
Asunto de la revista:
CARDIOLOGIA
Año:
2019
Tipo del documento:
Article