Impact of Publicly Reported Outcomes on Patient Selection for Hematopoietic Cell Transplantation.

PURPOSE: Public reporting of health care outcomes can have unintended effects such as inappropriate risk aversion in patient selection. METHODS: The center-specific survival analysis annually assigns all hematopoietic cell transplantation (HCT) centers in the United States a +1, -1, or 0 score for observed outcomes that are above, below, or within a center-specific predicted range of outcome. For each index year (2012-2016), centers receiving a -1 score after 0 scores in the preceding 2 years were compared with contemporaneous centers with as-predicted outcomes (0 score). Changes in the patient population characteristics in the 3 years before versus the 3 years after the index years were compared between the newly below-expected centers (NBCs) and the controls. A multivariate model adjusted for baseline patient population characteristics and center volume. RESULTS: No differences in patient selection behavior were identified when comparing the NBCs with the controls across eight key patient population characteristics. For the statistically modeled (predicted) 1-year overall survival (OS), reflecting a holistic measure of centers' patient population risk, we observed no statistically significant difference in change (-0.23% [95% CI, -1.4 to 0.9]; P = .70). The observed OS increased in both NBCs and controls by 0.9% and 4.5%, respectively, without statistically significant difference in change. CONCLUSION: Centers receiving a -1 score were not observed to deviate significantly from patient selection trends in the HCT field. These findings suggest that public reporting of HCT outcomes in the United States does not result in unintended bias against HCT for high-risk patients.

Duke Scholars

Author Jesse David Troy Biostatistics & Bioinformatics, Division of Biostatistics