BACKGROUND Heart transplantation (HT) survival and waitlist times are established outcome metrics. Patient-centered HT outcomes are insufficiently characterized. This study evaluates the role of days alive and outside the hospital (DAOH) as a candidate patient-centered HT performance measure. METHODS The study cohort included Medicare beneficiaries undergoing HT (July 2008-December 2017). The percent of days outside of hospital (%DOH) six months before (%DOH-BF) and percent of days alive outside of hospital 12 months after HT (%DAOH-AF) were evaluated along with adverse events (AEs, early: ≤3 months; late: 4-12 months). Patients were stratified by patient %DAOH-AF terciles. Risk-adjusted %DAOH was evaluated across hospitals. RESULTS A total of 5,104 beneficiaries underwent HT across 108 hospitals. Median [IQR] age was 62 [53-67] years, 23.9% were female, and 21.4% were African-American. The overall median %DOAH-AF was 92.9% [83.8%, 95.9%], varying by tercile: low: 71.8% [4.9%, 83.6%], intermediate; 92.9% [91%, 94%]; high 96.4% [95.9%, 97.3%]. The lowest (versus highest) tercile %DAOH-AF had a lower median %DOH-BF (88% [73%-97%] versus 92% [81%-98%]) and longer post-HT inpatient stay (54 [36-81] versus 13 [10-15] days). After HT, the lowest versus highest tercile had greater AEs burden in the early [allograft failure (16.1% versus 1.6%), stroke (12.1% versus 2.3%)], and late [stroke (5.1% versus 1.9%), sternal wound infection (5.0% versus 0.8%)] phases post-HT. Mean hospital %DAOHadj was 80.5% (min:max 57.7%-96.7%). CONCLUSIONS Post-HT %DAOH varies across beneficiaries and hospitals and is associated with AEs. Further research is warranted to assess the role and validity of %DAOH as a HT quality metric.

中文翻译：

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推进以患者为中心的心脏移植指标：存活天数和医院外的作用。


背景 心脏移植 （HT） 生存率和等待名单时间是已确定的结果指标。以患者为中心的 HT 结局没有得到充分表征。本研究评估了生存天数和院外天数 （DAOH） 作为以患者为中心的候选 HT 绩效测量的作用。方法 研究队列包括接受 HT （2008 年 7 月至 2017 年 12 月） 的 Medicare 受益人。评估 6 个月前出院天数百分比 （%DOH） 和 HT 后 12 个月出院天数百分比 （%DAOH-AF） 以及不良事件 （AEs，早期：≤3 个月;晚期：4-12 个月）。患者按患者 %DAOH-AF 三分位数分层。在各医院评估风险调整后的 %DAOH。结果 共有 5,104 名受益人在 108 家医院接受了 HT。中位 [IQR] 年龄为 62 [53-67] 岁，23.9% 为女性，21.4% 为非裔美国人。总体 %DOAH-AF 中位数为 92.9% [83.8%， 95.9%]，差异幅度为：低：71.8% [4.9%， 83.6%]，中等;92.9% [91%, 94%];高 96.4% [95.9%， 97.3%]。最低（相对于最高）的 %DAOH-AF 中位 %DOH-BF 较低 （88% [73%-97%] 对 92% [81%-98%]） 和 HT 后住院时间更长 （54 [36-81] 对 13 [10-15] 天）。HT 后，最低与最高三分体在 HT 后早期 [同种异体移植失败 （16.1% 对 1.6%）、中风 （12.1% 对 2.3%）] 和晚期 [中风 （5.1% 对 1.9%）、胸骨伤口感染 （5.0% 对 0.8%）] 阶段的 AEs 负担更大。平均医院 %DAOHadj 为 80.5% （min：max 57.7%-96.7%）。结论 HT 后 %DAOH 因受益人和医院而异，并与 AE 相关。有必要进一步研究以评估 %DAOH 作为 HT 质量指标的作用和有效性。