More on PSRs and SRTR
Last week's blog was written in anticipation of the SRTR-sponsored consensus conference on PSRs; I appreciate the responses received, including one from an old friend in a fairly prominent position who chose to reply personally. Was a very interesting meeting, with lots of open discussion and almost... but not quite... too much mathematics for me. Bottom line, SRTR, under its previous and current contractors, has produced a product unrivaled in American medicine. This was acknowledged by government, industry, and clinicians alike: our ability to collect and analyze accurate outcomes data uniquely equips transplantation to address whatever is coming down the pike in healthcare reform. That said, we can do better. Timeliness of cohorts is an issue with several alternatives that offer faster recognition of both emerging problems and effective remedies. There was strong support for center-specific offerings that would foster quality improvement for the field as a whole rather than just identify outliers, and some uncertainty regarding analysis of waiting list outcomes, particularly in kidney transplantation with long lists and patients not under the care of the transplant center. One recurring theme for both administrators and clinicians is to spend time understanding the PSRs with tools already available; failure to understand what is there and why it is there often can be a prelude to graver consequences.
Robert S. Gaston