Quality metrics in solid organ transplantation: a systematic review

Background The best approach for determining whether a transplant program is delivering high-quality care is unknown. This review aims to identify and characterize quality metrics in solid organ transplantation. Methods Medline, Embase, and Cochrane Central Register of Controlled Trials were searched from inception until February 1 2017. Relevant full text reports and conference abstracts that examined quality metrics in organ transplantation were included. Two reviewers independently extracted study characteristics and quality metrics from 52 full text reports and 24 abstracts. PROSPERO registration: CRD42016035353. Results 317 quality metrics were identified and condensed into 114 unique indicators with sufficient detail to be measured in practice, however, many lacked details on development and selection, were poorly defined, or had inconsistent definitions. The process for selecting quality indicators was described in only 5 publications and patient involvement was noted in only 1. Twenty-four reports used the indicators in clinical care, including 12 quality improvement studies. Only 14 quality metrics were assessed against patient and graft survival. Conclusions >300 quality metrics have been reported in transplantation but many lacked details on development and selection, were poorly defined or had inconsistent definitions. Measures have focused on safety and effectiveness with very few addressing other quality domains such as equity and patient-centeredness. Future research will need to focus on transparent and objective metric development with proper testing, evaluation, and implementation in practice. Patients will need to be involved to ensure that transplantation quality metrics measure what is important to them. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Corresponding author: Dr. Greg A Knoll, The Ottawa Hospital, 1967 Riverside Drive, Ottawa, Ontario, Canada, K1H 7W9. 613-738-8400 x82536; gknoll@toh.ca Authorship KB participated in study design, the literature search, data collection, data analysis, and writing of the article. LR, EE, and AB participated in data collection and revising the manuscript. GK participated in the study design, literature search, data analysis, and writing of the article. Disclosure The authors declare no conflicts of interest. Funding This study is funded by the Canadian Institutes of Health Research (#143239). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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