HIDDEN FIGURES: ARE WE LOOKING AT THE RIGHT METRICS FOR TRANSPLANT ACCESS
Prof. Stephen Mcdonald3, Ms KATIE CUNDALE2, Ms KELLI OWEN2, PROF JAQUELYNE HUGHES3
1University Of Adelaide, Adelaide, Australia, 2National Indigenous Kidney Transplant Taskforce, Adelaide, Australia, 3Flinders University Rural and Remote Health, Darwin, Australia
Aim: Evaluate performance of measures that monitor access to transplantation for Aboriginal and Torres Strait Islander people.
Background: Access to kidney transplantation for Aboriginal and Torres Strait Islander people in Australia is inequitable. Currently the ANZSN Quality Indicator program reports the proportion of people waitlisted or transplanted at 6 month by units as the metric for transplant access. Variation between units for Indigenous people is not known.
Methods: Data were extracted from ANZDATA Registry for people who started kidney replacement therapy (KRT) from 2017-2021 as well as prevalent numbers at 31/12/22. Quality indicators (QI) for transplantation included number/% of patients active the transplant waitlist or transplanted at six, 12, 24, and 36 months after commencing KRT, stratified by Indigenous status. Analyses were restricted to units (n=17) that had >10 Indigenous patients over the analysis period.
Results: Centre-specific transplant QIs at six months (QI6m) showed a poor relationship between Indigenous and non-indigenous groups – among units there was low correlation (r=0.54, p=0.02). QI6m was 0% for Indigenous people in 65% of centres, but for non-Indigenous people was 0% in only 5% of centres. For Indigenous-specific unit QIs there was little correlation between early and late transplant QIs (e.g. r=0.45 for QI for 6 vs 24 months). Examining the proportion of prevalent people (aged<65) at 31Dec22 waitlisted, there was a slightly stronger relationship (r=0.61, p<0.01)
Conclusions: The current ANZSN QI6m for transplantation access does not reflect access for Indigenous people at that unit, nor does the 6 month time point reflect subsequent waitlisting rates. Creating specific and relevant quality indicators for transplant access for Aboriginal and Torres Strait Islander people is critical to driving improvement.
Presentation Slides PDF – Click here
Biography:
Prof Stephen McDonald is Director of the Adelaide EpiCentre (Centre for Clinical Epidemiology) from Jan 2024. He is the Clinical Director of Renal Services for the SA Rural Support Service, chairs the SA Renal Community of Practice, and is Executive Officer of the Australia and New Zealand Dialysis and Transplant Registry.