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David Taber, Charles Bratton, Angello Lin, John McGillicuddy, Kenneth Chavin and Prabhakar Baliga Slide 2 Define Health Care Value Health Care Value in Kidney Transplant Current and future challenges Study Design Study Results Discussion and Conclusions OUTLINE Slide 3 RESULTS OF CARE COST NEJM 2010; 363:2477-81. (TRUE OUTCOMES per care cycle) (TOTAL OF ALL SERVICES to provide care during this cycle) Slide 4 Measuring Health Care Value in Kidney Txp OUTCOMES COSTS Patient and Graft Survival 1, 3, 5, 10 year Graft Function (GFR) 1, 3, 5, 10 year Acute Rejection 3, 6, 12 month Infections 6, 12, >12 month Peri-Operative Urine leak, wound infection, hernia, NODAT, HTN, acute MI, etc Indicators: LOS & Readmissions Organ Acquisition Surgery Medication Accommodations Imaging Laboratory PT/OT Clinic Visits Outpatient Procedures Additional Ancillary Slide 5 Increased use of marginal donors Slide 6 Higher risk donors (KDRI) KDRI 0.8 = 80% GS at 5 years KDRI 1.45 = 60% GS at 5 years Slide 7 Older Recipients Slide 8 More Comorbidities Slide 9 AJT 2008;8(3):586-92. Slide 10 Use of marginal donors and high-risk recipients has led to more complex post- operative management Stagnate or shrinking reimbursement rates Shrinking or negative net margins Future risks associated with lack of payment for readmissions Slide 11 Retrospective cross-sectional analysis Utilized both UHC and SRTR data Compare outcomes at our center, benchmarked to national data Before, during and after quality initiatives implemented Outcomes measured LOS, readmissions, in-hospital complications, costs Slide 12 STRUCTUREPROCESS Daily Rounds with Nephrologist Early dialysis for anuric/rising SrCr POD 2 review need for dialysis, reserve chair for 7 AM Coordinate with need for medications with long infusions (rATG, IVIG) Daily clinic visits with nephrologist Revised DGF Protocols Discharge on POD 3 with daily clinic follow up by nephrologist Early referral back to home dialysis chair Protocol biopsies Slide 13 Baseline Demographics MUSC Transplant Center National Transplant Centers P-value Age 18-34 35-49 50-64 65 15.3% 27.8% 38.4% 18.5% 14.0% 28.4% 41.2% 16.3% 0.317 Gender Male Female 58.5% 41.5% 60.8% 39.2% 0.258 Race/Ethnicity White Black Hispanic Asian Other 46.0% 50.8% 1.7% 0.9% 0.6% 53.6% 25.3% 14.2% 5.6% 1.4%