ABSTRACT
BACKGROUND: Shortfalls in deceased organ donation lead to shortages of solid organs available for transplantation. We assessed rates of deceased organ donation and compared hospitals that had clinical services for transplant recipients (transplant hospitals) to those that did not (general hospitals). METHODS: We conducted a population-based cohort analysis involving patients who died from traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage or other catastrophic neurologic conditions in Ontario, Canada, between Apr. 1, 1994, and Mar. 31, 2011. We distinguished between acute care hospitals with and without transplant services. The primary outcome was actual organ donation determined through the physician database for organ procurement procedures. RESULTS: Overall, 87,129 patients died from catastrophic neurologic conditions during the study period, of whom 1930 became actual donors. Our primary analysis excluded patients from small hospitals, reducing the total to 79,746 patients, of whom 1898 became actual donors. Patients who died in transplant hospitals had a distribution of demographic characteristics similar to that of patients who died in other large general hospitals. Transplant hospitals had an actual donor rate per 100 deaths that was about 4 times the donor rate at large general hospitals (5.0 v. 1.4, p < 0.001). The relative reduction in donations at general hospitals was accentuated among older patients, persisted among patients who were the most eligible candidates and amounted to about 121 fewer actual donors per year (adjusted odds ratio 0.58, 95% confidence interval 0.36-0.92). Hospital volumes were only weakly correlated with actual organ donation rates. INTERPRETATION: Optimizing organ donation requires greater attention to large general hospitals. These hospitals account for most of the potential donors and missed opportunities for deceased organ donation.
Subject(s)
Nervous System Diseases/mortality , Tissue Donors/supply & distribution , Tissue and Organ Procurement/statistics & numerical data , Adult , Aged , Cause of Death , Cohort Studies , Female , Hospitals , Humans , Male , Middle Aged , OntarioABSTRACT
Since the inception of the Hospital Reports in 1998, researchers have focused on three separate but related problems--how to measure performance; how to evaluate performance; and how to transfer knowledge about excellent performance to the field. This article describes a method to address the second problem--how to evaluate performance by benchmarking two indicators of financial performance and condition through three years of recent data for Ontario hospitals.
Subject(s)
Benchmarking/methods , Financial Audit/methods , Financial Management, Hospital/standards , Management Audit/methods , Health Care Surveys , Health Services Research , Hospital Administrators , Information Dissemination , Ontario , Social Responsibility , Surveys and Questionnaires , Total Quality ManagementABSTRACT
The notion of uniform terms and conditions speaks to equity of access--that fair rules apply in obtaining medically necessary services. However, when demand for medical services outweighs the supply of these services, the issue of "fair rules" concerning who comes first or who is most in need is a hotly debated subject. This debate has focused not just on how long patients may have to wait for access, but also on the question of how caregivers decide the priority of providing care. Central to this discussion is the need to develop a transparent methodology that fairly prioritizes patients based on urgency; timely access to services and acceptability to all stakeholders.
