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UNOS Update

UNOS Update. Stuart Sweet, MD, PhD Immediate Past-President, UNOS Board of Directors Region 4 August 25, 2017. OPTN/UNOS Strategic Planning. Brainstorming themes. Better matching Faster placement, including analysis of historical offer acceptance

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UNOS Update

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  1. UNOS Update Stuart Sweet, MD, PhD Immediate Past-President, UNOS Board of Directors Region 4 August 25, 2017

  2. OPTN/UNOS Strategic Planning

  3. Brainstorming themes • Better matching • Faster placement, including analysis of historical offer acceptance • Automated decision-making aids (risk/benefit calculator, time to next offer) • Use of behavioral research to improve system interface • Focus on improvement • Peer coaching, effective practice sharing, COIIN • Re-examine outcomes thresholds, including development of long-term outcomes • More data, more easily • APIs, automated connections to EMRs • User-friendly DonorNet and other tools (DonorNet mobile, multi-platform, interface design) • Analysis tools – ROO, RUM, benchmark reports

  4. Themes--Match More Equity Outcomes Safety Efficiency Match

  5. Themes--Data More Equity Outcomes Safety Efficiency Data

  6. Themes--Quality More Equity Outcomes Safety Efficiency Quality

  7. New plan structure • Combined OPTN and UNOS plans • Shared high-level goals • Description of current activities • Opportunities for growth • Metrics

  8. Plan Development Calendar 2017 • June: Board brainstorming session • July-Oct: Refining/seeking input November: ExCom/CAC review input/develop rough draft December: Board weighs in on rough draft ExCom and CAC finalize for PC

  9. Plan Development Calendar 2018 • Jan-March: Draft plan out for public comment • April: ExCom/CAC meet in-person, finalize plan June: Board approves final plan July: New plan is effective

  10. Cohort A Organ Acceptance Rate (50-100% KDPI) Kick-off and data collection Waitlist Management Organ Offer & Acceptance

  11. COIIN Benefits from Cohort A Teams • “Bringing team together around common goals” • “Collaboration with other centers” and “Hearing the issues discussed with other centers” • “The review of offer acceptance criteria brought a lot of opportunities to our attention” • “Increased awareness by entire team” • “COIIN helped our collaboration with the OPO” • “Transparent data across all participants and contact information for collaboration across centers”

  12. Next Steps

  13. Peds Benchmark Report

  14. Recovery and Usage Maps (RUM) Report

  15. Recovery and Usage Maps (RUM) Report

  16. Data Services Portal

  17. Up Next for the Data Portal

  18. Liver distribution

  19. Why Now?

  20. Liver Committee Work Plan Purpose: Revise exception eligibility criteria. Board Approved: Dec 2016 Purpose: Optimize the distribution system to reduce geographic variation in access to transplant Public Comment (2): July 31,2017 Purpose: Apply exception criteria uniformly. Board Approved: Jun 2017

  21. Enhancing Liver Distribution Proposing 11-region sharing with 150 mile proximity circle including out of region patients: • 5 additional MELD/PELD points to patients within proximity circle • Sequence: Local Status 1A,Peds 1B, Region plus proximity circle • Share to:Adults: lab MELD > 29Pediatrics: allocation MELD/PELD > 29 • DCD and donors > age 70 excluded from this sharing algorithm

  22. Fall Public Comment • Rationale for moving forward in parallel with additional modeling: • Direction and magnitude of impact on key metrics were consistent across older and newer cohorts. • Proposed solution will share to fewer proximity circle candidates than previous modeling (suggesting the prior modeling is a ceiling) • Sharing using MELD/PELD 29 threshold • Sharing based on lab MELD for adult candidates • Some additional modeling data will become available during public comment period

  23. Fall Public Comment • SRTR Modeling (preliminary results 8/11): • Results similar to prior analyses: • Significant Decrease in Median MELD variance at txp • No change in transport time, increases in % organs flown and transport distance smaller than prior proposals • No change in total transplants or post-transplant mortality. Waiting list mortality rate and totals decrease • Final Report will include impact on vulnerable populations • Will be posted on website and feedback sought (including webinar)

  24. Other OPTN/UNOS Activities • Ongoing Liver Committee Work: • Finalize disparity / impact metrics • Set targets for improvement • Additional policy modifications to meet disparity targets • System Optimization Proposal • Reduce time to access and respond to offers (60 to 30 min) • Limit decision time for primary offers to 60 minutes • Limit number of simultaneous acceptances to two donors • OPO / DSA Performance Metrics

  25. Moving Forward

  26. Volunteers are Valuable!! • 41,762 Volunteer hours • Average number of hours 1-2 hours per week • Connection to the Transplant community • Meaningful and impactful work Thank you!

  27. UNOS Update Stuart Sweet, MD, PhD Immediate Past-President, UNOS Board of Directors Region 4 August 25, 2017

  28. Questions – click hand button

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