Abstract：
BACKGROUND: Transplant center report cards are publicly available and used by regulators, insurance payers, and importantly patients and families.
OBJECTIVE: In this study, the authors sought to evaluate the variability in reported public performance ratings of pediatric and adult heart transplant centers.
METHODS: Program-specific reports from the Scientific Registry of Transplant Recipients from 2017-2021 were used to evaluate stability, volatility, and reliability of 3 publicly reported ratings: waitlist survival (WS), getting to a faster transplant (FT), and post-transplantation graft failure (GF).
RESULTS: There were 112 adult and 55 pediatric centers. Over the study period, nearly all centers (98%) had at least 1 change in rating in at least 1 of the tiers. The average time to the first rating change of any magnitude was 12-18 months for all tiers and centers. For adult centers, the most volatile rating was WS (SD: 0.77), followed by GF (SD: 0.76) and then FT (SD: 0.57). For pediatric centers, the most volatile rating was WS (SD: 0.79), followed by both GF (SD: 0.66) and FT (SD: 0.68), which were equally volatile. All tiers except adult FT had an estimated Fleiss\'s kappa <0.20, indicating poor agreement/consistency across the study period. In addition, the intraclass correlation coefficient for all tiers was <0.50, indicating poor reliability.
CONCLUSIONS: The current 5-tier reporting of transplant center performance is highly volatile and has poor reliability and consistency. Given the unintended and significant negative consequences these reports can have, critical revision of these ratings is warranted.
OBJECTIVE: In this study, the authors sought to evaluate the variability in reported public performance ratings of pediatric and adult heart transplant centers.
METHODS: Program-specific reports from the Scientific Registry of Transplant Recipients from 2017-2021 were used to evaluate stability, volatility, and reliability of 3 publicly reported ratings: waitlist survival (WS), getting to a faster transplant (FT), and post-transplantation graft failure (GF).
RESULTS: There were 112 adult and 55 pediatric centers. Over the study period, nearly all centers (98%) had at least 1 change in rating in at least 1 of the tiers. The average time to the first rating change of any magnitude was 12-18 months for all tiers and centers. For adult centers, the most volatile rating was WS (SD: 0.77), followed by GF (SD: 0.76) and then FT (SD: 0.57). For pediatric centers, the most volatile rating was WS (SD: 0.79), followed by both GF (SD: 0.66) and FT (SD: 0.68), which were equally volatile. All tiers except adult FT had an estimated Fleiss\'s kappa <0.20, indicating poor agreement/consistency across the study period. In addition, the intraclass correlation coefficient for all tiers was <0.50, indicating poor reliability.
CONCLUSIONS: The current 5-tier reporting of transplant center performance is highly volatile and has poor reliability and consistency. Given the unintended and significant negative consequences these reports can have, critical revision of these ratings is warranted.
摘要：
背景：移植中心的报告卡是公开的，并由监管机构使用，保险付款人,重要的是患者和家属。
目的：在本研究中，作者试图评估儿科和成人心脏移植中心报告的公共绩效评级的变异性.
方法：使用2017-2021年移植接受者科学注册中心的特定计划报告来评估稳定性，波动性，和3个公开报告的评级的可靠性：等待生存（WS），进行更快的移植（FT），和移植后移植物失败（GF）。
结果：共有112个成人中心和55个儿科中心。在学习期间，几乎所有中心(98%)在至少1个层级中至少有1次评级变化.对于所有等级和中心，首次评级变化的平均时间为12-18个月。对于成人中心，最不稳定的评级是WS(SD：0.77)，然后是GF(SD:0.76),然后是FT(SD:0.57)。对于儿科中心，最不稳定的评级是WS(SD：0.79)，其次是GF(SD:0.66)和FT(SD:0.68)，同样不稳定。除成人FT外，所有等级的估计Fleisskappa<0.20，表明整个研究期间的一致性/一致性较差。此外,所有层级的组内相关系数均<0.50,表明可靠性差.
结论：当前移植中心性能的5层报告具有很高的波动性，并且可靠性和一致性较差。鉴于这些报告可能会产生意想不到的重大负面影响，这些评级的关键修订是有必要的。
目的：在本研究中，作者试图评估儿科和成人心脏移植中心报告的公共绩效评级的变异性.
方法：使用2017-2021年移植接受者科学注册中心的特定计划报告来评估稳定性，波动性，和3个公开报告的评级的可靠性：等待生存（WS），进行更快的移植（FT），和移植后移植物失败（GF）。
结果：共有112个成人中心和55个儿科中心。在学习期间，几乎所有中心(98%)在至少1个层级中至少有1次评级变化.对于所有等级和中心，首次评级变化的平均时间为12-18个月。对于成人中心，最不稳定的评级是WS(SD：0.77)，然后是GF(SD:0.76),然后是FT(SD:0.57)。对于儿科中心，最不稳定的评级是WS(SD：0.79)，其次是GF(SD:0.66)和FT(SD:0.68)，同样不稳定。除成人FT外，所有等级的估计Fleisskappa<0.20，表明整个研究期间的一致性/一致性较差。此外,所有层级的组内相关系数均<0.50,表明可靠性差.
结论：当前移植中心性能的5层报告具有很高的波动性，并且可靠性和一致性较差。鉴于这些报告可能会产生意想不到的重大负面影响，这些评级的关键修订是有必要的。
