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What is Our Current National Multicultural Reality?

What is Our Current National Multicultural Reality?. Bob Carrico, PhD Senior Biostatistician UNOS. Number of Donors 2009 - 2012. Introduction / Outline. Can we find standout OPOs using current national DSA level data? Metric: Authorization Rate

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What is Our Current National Multicultural Reality?

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  1. What is Our Current National Multicultural Reality? Bob Carrico, PhD Senior Biostatistician UNOS

  2. Number of Donors 2009 - 2012

  3. Introduction / Outline • Can we find standout OPOs using current national DSA level data? • Metric: Authorization Rate • Authorization of Eligible Deaths – Percent by OPO. • By ethnicities: White, Black, Hispanic, Asian • Can we find statistical significance? • Where does this leave us?

  4. Implications • Speakers at this conference are invited based on this analysis • Data indicated that they are top performers • Want to find factors that influence this • Data • Geography and Population • Philosophies, Procedures, Techniques • How can this influence practice

  5. Authorization Rate 2009 - 2012

  6. Authorization Distribution: White

  7. Authorization Distribution: Black

  8. Authorization Distribution: Hispanic

  9. Authorization Distribution: Asian

  10. Authorization Distribution: All

  11. Analysis Technique • Odds Ratio: • Odds of Authorization for Candidate OPOs • Compare to adjusted average of other candidate OPOs and non-candidate OPOs • How to select OPOs to test when there are many • Which OPOs can be candidates? • Logistic Regression Models • Compute adjusted odds ratios • Are candidate OPOs more likely to authorize individuals of a given ethnicity? • Adjust for: • Age; Gender; Cause, Mechanism, and Circumstance of Death.

  12. Authorization Rates - White

  13. Authorization Rates - White OPO Mean Authorization Rate: 82.8%

  14. Authorization Rates - White Median Number of Eligible Deaths: 324 OPO Mean Authorization Rate: 82.8%

  15. Authorization Rates - White

  16. Authorization Rates - White

  17. Authorization Rates - White

  18. Top Performers: White • ILIP-OP1 – Gift of Hope • Crude Authorization Rate 90.8% • Adjusted Odds Ratio: 1.72 (p-value<0.01) • CORS-OP1 – Donor Alliance • Crude Authorization Rate 91.2% • Adjusted Odds Ratio: 1.60 (p-value=0.01) • PADV-OP1 – Gift of Life Donor Program • Crude Authorization Rate 88.0% • Adjusted Odds Ratio: 1.31 (p-value<0.01)

  19. Authorization Rates - Black

  20. Authorization Rates - Black OPO Mean Authorization Rate: 59.3%

  21. Authorization Rates - Black Median Number of Eligible Deaths: 91 OPO Mean Authorization Rate: 59.3%

  22. Authorization Rates - Black

  23. Authorization Rates - Black

  24. Authorization Rates - Black

  25. Top Performers: Black • TNMS-OP1 – Mid-South Transplant Foundation • Crude Authorization Rate 75.0% • Adjusted Odds Ratio: 1.51 (p-value=0.02) • MWOB-OP1 – Midwest Transplant Network • Crude Authorization Rate 70.7% • Adjusted Odds Ratio: 1.50 (p-value=0.04) • SCOP-OP1 – LifePoint, Inc. • Crude Authorization Rate 74.5% • Adjusted Odds Ratio: 1.47 (p-value<0.01) • ILIP-OP1 – Gift of Hope • Crude Authorization Rate 69.9% • Adjusted Odds Ratio: 1.33 (p-value=0.01)

  26. Authorization Rates - Hispanic

  27. Authorization Rates - Hispanic OPO Mean Authorization Rate: 66.2%

  28. Authorization Rates - Hispanic 75th Percentile Number of Eligible Deaths: 105 OPO Mean Authorization Rate: 66.2%

  29. Authorization Rates - Hispanic

  30. Authorization Rates - Hispanic

  31. Authorization Rates - Hispanic

  32. Top Performers: Hispanic • ILIP-OP1 – Gift of Hope • Crude Authorization Rate 83.7% • Adjusted Odds Ratio: 1.84 (p-value<0.01) • PRLL-OP1– LifeLink of Puerto Rico • Crude Authorization Rate 81.1% • Adjusted Odds Ratio: 1.59 (p-value<0.01)

  33. Authorization Rates - Asian

  34. Authorization Rates - Asian OPO Mean Authorization Rate: 54.5%

  35. Authorization Rates - Asian 75th Percentile Number of Eligible Deaths: 25 OPO Mean Authorization Rate: 54.5%

  36. Authorization Rates - Asian

  37. Authorization Rates - Asian

  38. Top Performers: Asian • Data does not suggest that there exist any statistically significant top performing OPOs in authorization of Asian eligible deaths.

  39. Authorization Rates 2009-2012: National Significance

  40. Analytical Limitations • Multivariable Analysis • Can only adjust models for data we have • Fit models separately for ethnicities • Missing significant factors • Identify other top performers

  41. Unavailable Data • Socio-Economic Status (SES) • Zip code on DNR form is missing for many non-donors. • Missingness keeps zip code from being used for national analyses • Zip Code • Relates donor to their socio-economic lifestyles and circumstances • Current analysis does not separate ethnicities by their lifestyles or circumstances. • These are likely indicative of donation potential and hence authorization rate.

  42. Where is the data? • OPOs house more data than we can aggregate nationally • Locally, OPOs are able to use their data and knowledge of their demographics to look at the same trends in their population

  43. Questions? Bob.Carrico@UNOS.org

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