J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 14, Number 3, March 2022, pages 111-118

Impact of Change in Allocation Score Methodology on Post Kidney Transplant Average Length of Stay

**Table 1.** Patient Characteristics
	Allocation score change	Significance
Prior to allocation score change was from 2011 to 2014. Post to allocation score change was from 2015 to 2018. SD: standard deviation.
Year					0.000
2011	895	25.42%	0	0.00%
2012	850	24.14%	0	0.00%
2013	887	25.19%	0	0.00%
2014	889	25.25%	0	0.00%
2015	0	0.00%	988	23.12%
2016	0	0.00%	1,006	23.54%
2017	0	0.00%	1,030	24.10%
2018	0	0.00%	1,250	29.25%
Transferred to					0.000
Home	2,698	76.63%	3,421	80.04%
Home with home health	823	23.37%	853	19.96%
Gender					0.016
Male	2,106	59.81%	2,668	62.42%
Female	1,415	40.19%	1,606	37.58%
Dialysis					0.000
No	2,942	83.56%	3,246	75.95%
Yes	579	16.44%	1,028	24.05%
Race/ethnicity
Non-Hispanic white	1,641	46.61%	1,653	38.68%	0.000
Non-Hispanic black	1,015	28.83%	1,375	32.17%
Hispanic	643	18.26%	937	21.92%
Other	222	6.31%	309	7.23%
Elixhauser Comorbidity
Diabetes	1,118	31.75%	1,489	34.84%	0.005
Cardiovascular disease	984	27.95%	1,244	29.11%	0.272
Cancer	17	0.48%	25	0.58%	0.542
Hypertension	3,353	95.23%	4,061	95.02%	0.582
Neurological disorders	119	3.38%	135	3.16%	0.579
Psychiatric illness	296	8.41%	320	7.49%	0.131
Anemia	100	2.84%	99	2.32%	0.143
	Mean	SD	Mean	SD
Length of stay	6.52	4.36	6.08	4.17	0.000
Age	50.78	16.02	51.06	15.99	0.449
Elixhauser Comorbidity Index	3.89	1.60	4.00	1.56	0.006
Elixhauser Comorbidity Index without diabetes	3.58	1.45	3.64	1.42	0.043

Table 1. Patient Characteristics

Allocation score change

Significance

Prior

Post

Frequency

Prior to allocation score change was from 2011 to 2014. Post to allocation score change was from 2015 to 2018. SD: standard deviation.

Year

0.000

2011

895

25.42%

0.00%

2012

850

24.14%

0.00%

2013

887

25.19%

0.00%

2014

889

25.25%

0.00%

2015

0.00%

988

23.12%

2016

0.00%

1,006

23.54%

2017

0.00%

1,030

24.10%

2018

0.00%

1,250

29.25%

Transferred to

0.000

Home

2,698

76.63%

3,421

80.04%

Home with home health

823

23.37%

853

19.96%

Gender

0.016

Male

2,106

59.81%

2,668

62.42%

Female

1,415

40.19%

1,606

37.58%

Dialysis

0.000

2,942

83.56%

3,246

75.95%

Yes

579

16.44%

1,028

24.05%

Race/ethnicity

Non-Hispanic white

1,641

46.61%

1,653

38.68%

0.000

Non-Hispanic black

1,015

28.83%

1,375

32.17%

Hispanic

643

18.26%

937

21.92%

Other

222

6.31%

309

7.23%

Elixhauser Comorbidity

Diabetes

1,118

31.75%

1,489

34.84%

0.005

Cardiovascular disease

984

27.95%

1,244

29.11%

0.272

Cancer

0.48%

0.58%

0.542

Hypertension

3,353

95.23%

4,061

95.02%

0.582

Neurological disorders

119

3.38%

135

3.16%

0.579

Psychiatric illness

296

8.41%

320

7.49%

0.131

Anemia

100

2.84%

2.32%

0.143

Mean

Length of stay

6.52

4.36

6.08

4.17

0.000

Age

50.78

16.02

51.06

15.99

0.449

Elixhauser Comorbidity Index

3.89

1.60

4.00

1.56

0.006

Elixhauser Comorbidity Index without diabetes

3.58

1.45

3.64

1.42

0.043

**Table 2.** Matching and Balancing Procedure Sample of Patients Transferred to Home
	All (N = 6,119)	Prior to allocation score change (N = 2,698)	PS unmatched effect size*	PS unmatched P-value	Matched prior to allocation score change (N = 1,592)	Post to allocation score change (N = 3,421)	PS matched effect size*	PS matched P-value
Data from The Agency for Health Care Administration from 2011 to 2018. Prior to allocation score change was from 2011 to 2014. Post to allocation score change was from 2015 to 2018. *Absolute standardized mean difference (Magnet-matched)/(pooled standard deviation) < 0.1. PS: propensity score.
Hospital number	-	-	0.07	0.003	-	-	0.01	0.775
Age	50.17	50.29	0.14	0.584	50.14	50.07	0.01	0.846
Elixhauser Comorbidity Index	3.62	3.57	0.06	0.011	3.61	3.67	0.05	0.141
Gender				0.047				0.379
Male	61.99	60.6			64.1	63.08
Female	38.01	39.4	0.05		35.9	36.92	0.01
Race/ethnicity				0.000				0.689
Non-Hispanic White	44.93	51.07			41.54	40.08
Non-Hispanic Black	29.11	26.83	0.08		31.13	30.9	0.04
Hispanic	18.81	14.83	0.18		18.04	21.95	0.01
Other	7.16	7.26	0.01		9.3	7.07	0.01
Dialysis				0.000				0.525
No	80.7	84.43			77.11	77.76
Yes	19.3	15.57	0.17		22.8	22.24	0.03
Diabetes				0.138				0.405
No	68.92	69.9			69.07	68.14
Yes	31.08	30.1	0.04		30.93	31.86	0.01

Table 2. Matching and Balancing Procedure Sample of Patients Transferred to Home

All (N = 6,119)

Prior to allocation score change (N = 2,698)

PS unmatched effect size*

PS unmatched P-value

Matched prior to allocation score change (N = 1,592)

Post to allocation score change (N = 3,421)

PS matched effect size*

PS matched P-value

Data from The Agency for Health Care Administration from 2011 to 2018. Prior to allocation score change was from 2011 to 2014. Post to allocation score change was from 2015 to 2018. *Absolute standardized mean difference (Magnet-matched)/(pooled standard deviation) < 0.1. PS: propensity score.

Hospital number

0.07

0.003

0.01

0.775

Age

50.17

50.29

0.14

0.584

50.14

50.07

0.01

0.846

Elixhauser Comorbidity Index

3.62

3.57

0.06

0.011

3.61

3.67

0.05

0.141

Gender

0.047

0.379

Male

61.99

60.6

64.1

63.08

Female

38.01

39.4

0.05

35.9

36.92

0.01

Race/ethnicity

0.000

0.689

Non-Hispanic White

44.93

51.07

41.54

40.08

Non-Hispanic Black

29.11

26.83

0.08

31.13

30.9

0.04

Hispanic

18.81

14.83

0.18

18.04

21.95

0.01

Other

7.16

7.26

0.01

9.3

7.07

0.01

Dialysis

0.000

0.525

80.7

84.43

77.11

77.76

Yes

19.3

15.57

0.17

22.8

22.24

0.03

Diabetes

0.138

0.405

68.92

69.9

69.07

68.14

Yes

31.08

30.1

0.04

30.93

31.86

0.01

**Table 3.** Matching and Balancing Procedure Sample of Patients Transferred to Home With Home Health Services
	All (N = 1,676)	Prior to allocation score change (N = 823)	PS unmatched effect size*	PS unmatched P-value	Matched prior to allocation score change (N = 437)	Post to allocation score change (N = 852)	PS matched effect size*	PS matched P-value
Data from The Agency for Health Care Administration from 2011 to 2018. Prior to allocation score change was from 2011 to 2014. Post to allocation score change was from 2015 to 2018. *Absolute standardized mean difference (Magnet-matched)/(pooled standard deviation) < 0.1. PS: propensity score.
Age	53.75	52.4	0.17	0.000	55.5	55.04	0.03	0.539
Elixhauser Comorbidity Index	3.59	3.61	0.03	0.557	3.65	3.57	0.02	0.239
Gender				0.288				0.372
Male	58.53	57.23			61.9	59.79
Female	41.47	42.77	0.05			40.21	0.07
Race/ethnicity				0.897	38.1			0.425
Non-Hispanic White	32.52	31.96			31.18	33.06
Non-Hispanic Black	36.34	35.36	0.04		39.04	37.28	0.02
Hispanic	25.6	29.53	0.17		27.32	21.81	0.03
Other	5.55	3.16	0.2		Oct-76	7.85	0.02
Dialysis				0.000				0.795
No	74.58	80.68			68.11	68.7
Yes	25.42	19.32	0.28		31.89	31.3	0.03
Diabetes				0.001				0.922
No	61.34	65.25			57.8	57.63
Yes	28.66	34.75	0.16		42.2	42.37	0.03

Table 3. Matching and Balancing Procedure Sample of Patients Transferred to Home With Home Health Services

All (N = 1,676)

Prior to allocation score change (N = 823)

PS unmatched effect size*

PS unmatched P-value

Matched prior to allocation score change (N = 437)

Post to allocation score change (N = 852)

PS matched effect size*

PS matched P-value

Age

53.75

52.4

0.17

0.000

55.5

55.04

0.03

0.539

Elixhauser Comorbidity Index

3.59

3.61

0.03

0.557

3.65

3.57

0.02

0.239

Gender

0.288

0.372

Male

58.53

57.23

61.9

59.79

Female

41.47

42.77

0.05

40.21

0.07

Race/ethnicity

0.897

38.1

0.425

Non-Hispanic White

32.52

31.96

31.18

33.06

Non-Hispanic Black

36.34

35.36

0.04

39.04

37.28

0.02

Hispanic

25.6

29.53

0.17

27.32

21.81

0.03

Other

5.55

3.16

0.2

Oct-76

7.85

0.02

Dialysis

0.000

0.795

74.58

80.68

68.11

68.7

Yes

25.42

19.32

0.28

31.89

31.3

0.03

Diabetes

0.001

0.922

61.34

65.25

57.8

57.63

Yes

28.66

34.75

0.16

42.2

42.37

0.03

**Table 4.** Propensity Score Model Results
Length of stay	Kidney Transplant Allocation Score (0 = Prior, 1 = Post)
P < 0.05, P < 0.01, **P < 0.001. Prior to allocation score change was from 2011 to 2014. Post to allocation score change was from 2015 to 2018. CI: confidence interval.
Transplant patients transferred to home	5,013	-0.68***	-0.95, -0.42
Transplant patients transferred to home with home health	1,289	-1.90***	-2.69, -1.11

Table 4. Propensity Score Model Results

Length of stay

Kidney Transplant Allocation Score (0 = Prior, 1 = Post)

Coefficient

95% CI

*P < 0.05, **P < 0.01, ***P < 0.001. Prior to allocation score change was from 2011 to 2014. Post to allocation score change was from 2015 to 2018. CI: confidence interval.

Transplant patients transferred to home

5,013

-0.68***

-0.95, -0.42

Transplant patients transferred to home with home health

1,289

-1.90***

-2.69, -1.11