Faculty Collaboration Database

Association of transplant center and physician factors on mortality after hematopoietic stem cell transplantation in the United States. Blood 2005 Apr 01;105(7):2979-87

Date

12/16/2004

Pubmed ID

15598815

DOI

10.1182/blood-2004-10-3863

Scopus ID

2-s2.0-20144389335 (requires institutional sign-in at Scopus site)   83 Citations

Abstract

The effect of the organization and delivery of health care at medical centers, referred to as "center effects," with clinical outcomes after hematopoietic stem cell transplantation (HSCT) is not clear. We examined the association between center and treatment provider factors and mortality after HSCT. We surveyed 163 (87% response rate) United States transplantation centers that performed HLA-identical sibling HSCT for leukemia or autologous HSCT for lymphoma between 1998 and 2000 among patients at least 18 years old. One hundred thirteen (69%) centers performed HLA-identical sibling transplantations, whereas 162 (99%) performed autologous transplantations. Factors associated with decreased 100-day mortality in the allogeneic setting include a higher patient-per-physician ratio (P = .003) and centers where physicians answer calls after office hours (P = .03). Medical school affiliation was not associated with increased 100-day mortality except in centers where students/residents are present without fellows (P = .02). Center effects were weaker in autologous HSCT at 1 year. Differences in 100-day mortality in patients receiving transplants in centers with favorable versus unfavorable factors were greater in allogeneic than autologous HSCT. Greater physician involvement in patient care is important in producing favorable outcomes after HSCT. To more clearly establish the role of the factors we identified, further studies are recommended.

Author List

Loberiza FR Jr, Zhang MJ, Lee SJ, Klein JP, LeMaistre CF, Serna DS, Eapen M, Bredeson CN, Horowitz MM, Rizzo JD

Authors

Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of Wisconsin
Mary M. Horowitz MD, MS Professor in the Medicine department at Medical College of Wisconsin
J. Douglas Rizzo MD, MS Director, Center Associate Director, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
General Surgery
Hematopoietic Stem Cell Transplantation
Hospital Mortality
Humans
Internship and Residency
Leukemia
Medical Staff, Hospital
Multivariate Analysis
Risk Factors
United States