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LONGER TERM
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Task |
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Study Bayesian Hierarchical Modeling Strategies.
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We are finalizing membership of a subcommittee of the STAC to focus on statistical methodologies. Invitations have gone out and some have been accepted. We will finalize the STAC-PSR subcommittee membership at the July 2012 STAC meeting and then look to convene the first STAC-PSR subcommittee meeting. We reviewed the 2012 COPSS-CMS Report on "Statistical Issues on Assessing Hospital Performance"(http://nisla05.niss.org/copss/COPSS_CMS_Report.pdf) at the May 2012 STAC meeting, and we will use the COPSS report as a guiding document and will explore these recommendations as part of the first tasks for the STAC-PSR subcommittee.
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Study setting missing data values to the least beneficial value when risk adjustment models are applied.
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Will consider as part of the roll-out of new models that are built in the 3-year cycle.
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Study inclusion of short-term living donor outcomes in the PSRs.
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We are reviewing options with the STAC at the July 2012 meeting. Will refine the metrics for possible inclusion in future PSR cycles for liver and kidney donors.
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Study Life-Years from Listing (LYFL) for inclusion in the PSRs.
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No timeline as of yet.
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Study using period analyses to estimate survival rather than the historical cohorts currently used. This will possibly enable estimates of long-term patient outcomes based on the most recent data available.
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Incorporated some of this work into the SRTR/OPTN annual data report. Will continue to explore methodologies for possible inclusion in the PSRs.
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Study measures of center aggressiveness for inclusion in the PSRs.
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We will present various ideas to the STAC at the July 2012 meeting to seek feedback and recommendations. No timeline for implementation as of yet.
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Study inclusion of data regarding what future PSRs will look like given events already observed. Likely for the secure site only.
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Planning to explore modifications to the Excel-based tools provided by the SRTR.
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Study Balanced Score Card approaches, including the current CPM under study by MPSC and extensions of the CPM to include pre- and post-transplant metrics.
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Currently addressing organ- and offer-acceptance rate models using the post-DonorNet match run data. Will begin to address additional components of the CPM, including waiting list mortality rates and transplant rates for liver and kidney programs.
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Continue to support the MPSC’s exploration of alternative flagging methodologies, possibly incorporating results from the Bayesian modeling.
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MPSC voted to move forward with the alternate flagging methodology presented to the MPSC at the March 2012 meeting. SRTR will provide the MPSC with both the traditional flag and the alternative flags for the upcoming July 2012 PSR cycle. Will move to the alternative flag pending UNOS board review and approval. Will continue to explore flagging during exploration of the Bayesian modeling approach.
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Work with the OPTN to explore the concept of excluding patients from the PSR cohorts that are in approved clinical studies.
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Was discussed at the March 2012 MPSC meeting. Dr. Roberts and Dr. Reed, past chair and vice-chair, were working toward assembling a subcommittee of the MPSC to explore this idea. No update since the March 2012 MPSC meeting.
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Explore the potential of additional risk adjustment for: More detailed data on donor/organ risk, possibly including more data from DonorNet®.
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Will be exploring this as part of the kidney model rebuild which is currently underway.
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Explore the potential of additional risk adjustment for: Socioeconomic status (SES) based on recipient ZIP code
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Exploration has been done by Dr. Hunsicker and Dr. Schold. Results were presented to the STAC at the May 2012 meeting. The general conclusion was that ZIP code-based measures of SES did not significantly improve the PSR models or change which programs were flagged. Will explore again as part of the kidney model rebuild that is currently underway.
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Explore the potential of additional risk adjustment for: More detailed data on diabetes (needs additional data collection by OPTN).
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No timeline as of yet. The pancreas committee is working to add more detailed data on diabetes to the forms.
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Explore the potential of additional risk adjustment for: Coronary heart disease, revascularizations (needs additional data collection by OPTN)
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No timeline as of yet, pending additional data collection.
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Explore the potential of additional risk adjustment for: Peripheral vascular disease, revascularizations, amputations (needs additional data collection by OPTN)
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No timeline as of yet, pending additional data collection.
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Explore the potential of additional risk adjustment for: Ventricular Assist Devices
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No timeline as of yet.
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Explore the potential of additional risk adjustment for: Study measures of organ function, e.g. acute rejections, eGFR, FEV1.
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No timeline as of yet.
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Study use of external data sources to estimate re-hospitalization or cause-specific post-transplant hospitalization rates, e.g., Medicare data.
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No timeline as of yet.
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Study inclusion of data-completeness indicators in the PSRs.
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No timeline as of yet.
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Study the possibility of including quality of life as an outcome (currently no data available to the SRTR).
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No timeline as of yet.
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