Public Reporting of Heart Transplant Center Performance: Promoting Clarity or Causing Confusion?

Abstract

Transplant center report cards are publicly available and used by regulators, insurance payers, and importantly patients and families. In this study, the authors sought to evaluate the variability in reported public performance ratings of pediatric and adult heart transplant centers. Program-specific reports from the Scientific Registry of Transplant Recipients from 2017-2021 were used to evaluate stability, volatility, and reliability of 3 publicly reported ratings: waitlist survival (WS), getting to a faster transplant (FT), and post-transplantation graft failure (GF). There were 112 adult and 55 pediatric centers. Over the study period, nearly all centers (98%) had at least 1 change in rating in at least 1 of the tiers. The average time to the first rating change of any magnitude was 12-18months for all tiers and centers. For adult centers, the most volatile rating was WS (SD: 0.77), followed by GF (SD: 0.76) and then FT (SD: 0.57). For pediatric centers, the most volatile rating was WS (SD: 0.79), followed by both GF (SD: 0.66) and FT (SD: 0.68), which were equally volatile. All tiers except adult FT had an estimated Fleiss's kappa<0.20, indicating poor agreement/consistency across the study period. In addition, the intraclass correlation coefficient for all tiers was<0.50, indicating poor reliability. The current 5-tier reporting of transplant center performance is highly volatile and has poor reliability and consistency. Given the unintended and significant negative consequences these reports can have, critical revision of these ratings is warranted.