Patient and transplant center factors associated with 100D mortality after receiving allogeneic hematopoietic stem cell transplantation (HSCT). J Clin Oncol 2004 Jul 15;22(14_suppl):6026
Date
07/15/2004Pubmed ID
28015094Abstract
: 6026 Background: "Center effects" are differences in outcomes that cannot be explained by identifiable differences in patients' diseases or treatments, and are presumed to result from variation in health care delivery. We examined the association of patient's clinical severity and transplant (TX) center factors, including procedure volume, with mortality after HSCT.
METHODS: We surveyed 116 US TX centers performing allogeneic TX in 1998-2000 and registering with IBMTR. Data on physicians and other health care providers, TX unit procedures and resources, and medical center organization were obtained. This analysis was limited to 88 centers that performed matched sibling HSCT for leukemia in adults (n=1426). A clinical severity score (CSS) was derived using patient-, disease-, and TX-related factors by modeling 100-day (100D) mortality. Then, a logistic regression model was fit to evaluate the association between 100D mortality and CSS and all TX center factors.
RESULTS: No differences in the clinical severity spectrum according to center factors was seen. Factors associated with 100D mortality included: patient's clinical severity, physician-patient ratio, presence of medical trainees, having nurses as initial contact person for emergency or after hours call rather than physicians, and affiliation with a medical school. Procedure volume and center experience were not associated with 100D mortality. In the multivariate analysis, higher clinical severity of patients (p<0.001), physician to patient ratio > 1:12 (p=0.02), having nurses take calls (p=0.02), and affiliation with a medical school (p=0.04) remained associated with mortality.
CONCLUSIONS: Our data suggest that clinical severity is the major predictor of 100D mortality and not procedure volume or TX center experience. However, two modifiable center factors, not previously associated with early mortality or TX center size, were identified: patients to physicians ratio and using nurses to take calls. We recommend further investigation to determine whether modification of these center factors leads to improvement in survival. No significant financial relationships to disclose.