Association of Transit Time With Cold Ischemic Time in Kidney Transplantation

This cross-sectional study examines the association between transit time and cold ischemic time for adult, deceased kidney transplant donors.

Are Online Patient Reviews Associated With Health Care Outcomes? A Systematic Review of the Literature

Although online patient reviews (OPRs) are ubiquitous, there has been debate about whether OPRs are associated with measures of health care outcomes. The majority of patients search for online information about a hospital or provider before scheduling an encounter, therefore, the extent to which OPRs are valid information is important. We conducted a systematic review of the literature to examine the extent to which OPRs are associated with measures of patient experience, clinical quality, and other outcomes. We searched Medline, CINAHL, Web of Science, and PsycInfo, which yielded 32 studies. There were consistent positive correlations between OPRs and patient experience at both the organization and individual provider levels of analysis. However, associations between OPRs and quality measures were mixed. Organizational level OPRs may be more reliable than individual provider OPRs. In addition, the strength of association could be affected by the type of encounter setting, specialty, and specific measures.

Can donor narratives yield insights? A natural language processing proof of concept to facilitate kidney allocation

Although expedited placement could ameliorate stagnant kidney utilization, precisely identifying difficult-to-place organs is crucial to mitigate potential harms associated with this policy. Existing algorithms have only leveraged structured data from the Organ Procurement and Transplantation Network (OPTN); however, detailed, free text case information about a donor exists. No known research exists about the utility of these data. We developed a model to predict the probability of delay or discard for adult deceased kidney donors between 2010 and 2018, leveraging donor free text data. The resultant model had a c-statistic of 0.75 compared to 0.80 ( Reduced Probability of Delay or Discard [model], r-PODD) and 0.77 ( Kidney Donor Profile Index, KDPI) on the test dataset. Analysis of the top predictive words suggest both known and potentially novel clinical factors (ie, a known factor such as hypertension vs a novel factor such as stents), and nuanced social factors (intravenous drug use) could negatively affect kidney utilization. These findings suggest that donor narratives have utility; the natural language processing (NLP) model is only moderately correlated with existing indices and provides directional evidence about additional cardiovascular risk factors that may affect kidney utilization. More research is needed to understand the potential to enhance existing indices of kidney utilization to better enable and mitigate the effects of policy interventions such as expedited placement.

Longitudinal Clustering of High-cost Patients' Spend Trajectories:Delineating Individual Behaviors from Aggregate Trends

For the past decade, there has been a concerted effort to fulfill the promises of the Triple Aim-improving patient experience and quality while lowering costs by focusing on high-cost patients via Care Management. Despite the well-known fact that high-cost patients make up roughly half of all annual medical expenses, little has been studied about high-cost patients' cost trajectories. This paper focuses on the trajectory patterns for high-cost Medicare patients, which provides another dimension to understanding optimal program intervention. We performed a retrospective observational study employing Longitudinal K-Means Clustering. We discovered there are two major categories based on overall utilization: "persistent" and "episodic". Both cohorts churn to some degree in the post high-cost year. These results highlight that high-cost patients churn, and the existence of high-cost patient sub-cohorts warrant further exploration around the patient profile for each cohort. This finding could influence the current dialogue about the understanding and ability to impact high-cost patients through appropriate intervention and, more importantly, at the right time to attenuate the cost and improve quality of care.