Title: Facility profiling under competing risks using multivariate prognostic scores: Application to kidney transplant centers
Authors: Youjin Lee - University of Pennsylvania (United States) [presenting]
Douglas Schaubel - University of Pennsylvania (United States)
Abstract: The performance of healthcare facilities (e.g., hospitals, transplant centers) is often evaluated through time-to-event outcomes. We consider the case where, for each subject, the failure event is due to one of several mutually exclusive causes (competing risks). Since the distribution of patient characteristics may differ greatly by center, some form of covariate adjustment is generally necessary in order for center-specific outcomes to be accurately compared (to each other or to an overall average). We propose methods for comparing facility-specific cumulative incidence functions (CIF) to an overall average. The methods involve directly standardizing each facility's non-parametric CIF through a weight function constructed from a multivariate prognostic score. We formally define the center-specific estimands with a causal interpretation, and establish conditions for their identification. We derive large-sample properties of the proposed estimators, and evaluate operating characteristics through simulation. We then apply the proposed methods to evaluate the center-specific pre-transplant mortality and transplant CIFs using data from the Scientific Registry of Transplant Recipients.