Fig. 1

Drivers of Clinical and Financial Outcomes for Kidney Transplant Patients Admitted for Inpatient Care for Cardiovascular Events. This conceptual model encapsulates the factors that contribute to outcomes when a kidney transplant recipient is admitted for inpatient care for a cardiovascular event. Kidney transplant patients admitted to hospitals with cardiovascular dysfunction are a complex population. They require multi-disciplinary coordinated care, multiple levels of acute inpatient care, comprehensive nephrology and cardiology services, specialized imaging and therapeutic capabilities, and other resources to address deterioration of kidney function, threatened allografts, immunosuppression, and numerous other queries. Well-resourced hospitals may be better equipped to prevent adverse outcomes when cardiovascular events occur in this population. Our analysis employed multi-level statistical models based on the Donabedian model of health care quality, with risk-adjustment for 1) patient characteristics, 2) key facility structural factors, which include organizational elements, facilities and services, as well as ownership and financial status, and 3) processes of care that appropriately utilize facilities and services to deliver treatment. Based on this structure, we hypothesized that transplant hospitals would have better clinical and financial outcomes than non-transplant hospitals from cardiovascular events in the kidney transplant population