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Standard B4.7.5 & benchmarking transplant outcome

"The 6th edition of the FACT-JACIE Standards places increased emphasis on outcome analysis and improvement.  Under Standard B4.7.5 (The Clinical Program should achieve one-year survival outcome within or above the expected range when compared to national or international outcome data) clinical programs are required to assess at least 100 day and one year survival, and to compare one year survival to national or international outcome data.

For information regarding this or any other aspect of JACIE, centres should direct their enquiries to the JACIE Accreditation Office at 
jacie@ebmt.org.

From the Accreditation Manual, 6th edition, pp. 72-73:

Explanation:
With the introduction of published comparative national and international data, Clinical Programs have additional resources to evaluate their one-year survival rates and improve upon them when they fall below expected ranges.  Emphasis on program defined longer-term benchmarking against national and international data is expected to receive more scrutiny in the development of future transplant quality review across the healthcare enterprise. Because improving one-year survival when outcome within the expected range is not met requires a detailed and often lengthy process of root cause analysis and performance improvement, Clinical Programs should begin studying their outcome data and taking the appropriate steps.

In the US, it expected that Clinical Programs performing allogeneic transplant will utilize the CIBMTR Stem Cell Therapeutic Outcomes  Database reports to demonstrate patient outcomes within the expected range, at a minimum. Reporting center-specific survival rates is a requirement of the Stem Cell Therapeutic and Research Act of 2005 (reauthorized in 2010). CIBMTR has the contract to report these data. Because transplant centers vary considerably in the risk level of patients treated, a statistical model was developed to adjust for several risk factors known or suspected to influence outcome. Although these data are only available for one-year overall survival for recipients  of allogeneic HCT transplant in the US, programs are encouraged to use these data for quality improvement initiatives.  Programs should also have internal benchmarks for other significant outcomes.

Some regions of the world may not have comparison data readily available. Clinical Programs in those areas should use published literature to establish a benchmark for use in evaluating their one-year survival.

Evidence:
Outcome data will be reported to the FACT or JACIE office prior to on-site inspections and also at interim reporting. If expected outcomes are not met, the Clinical Program must submit a corrective action plan prior to being awarded accreditation.

Example(s):
In the U.S., programs will provide  their outcomes  as published in the CIBMTR  Transplant Center Survival Report. European programs will use similar national schemes,  for example, the British Society of Blood and Marrow Transplantation (BSBMT) and Swiss Blood Stem Cell Transplant Group (SBST).