Susan L. Smith, MN, PhD


March 31, 2003

Variation: The Achilles' Heel of Outcomes

There is considerable geographic variation in expenditures and outcomes in transplantation. In an analysis of the 10 most active kidney transplant centers in the United States, Evans and Kitzmann[4] demonstrated considerable variation in survival among these centers. The range for 3-year graft and patient survival in this analysis was 60.4% to 81.6% and 84.9% to 95.7%, respectively. Charges, based on Medicare Part A charges for inpatient hospitalization for the surgical admission, ranged from $49,500 to $90,500.

Variation in transplant outcomes has historically been justified on the basis that transplantation is "different." And indeed, transplantation remains different in at least 1 respect -- the need to highly individualize immunosuppressive therapy on the basis of type of transplant, age, ethnic origin, etiology of end-organ disease, posttransplant complications, and other factors. The bottom line, however, is that the viability of transplant programs in a competitive healthcare market continues to be dependent on the financial bottom line. Healthcare payers focus on variation in resource utilization as an indicator of deviation from expected outcomes. Thus, measurement of resource utilization for disease groups and patient populations is an important part of outcomes assessment. Unfortunately, this is where it begins and ends for some institutions. However, measuring variation without identifying the root causes leaves you without opportunities for improvement in outcomes.


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