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Abstract: FR-PO1137

Standardizing and Optimizing Blood Pressure Measurement Across 16 Pediatric Transplant Centers: The Improving Renal Outcomes Collaborative

Session Information

  • Pediatric Nephrology - I
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology


  • Seifert, Michael E., University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Garro, Rouba, Emory Children's Center, Atlanta, Georgia, United States
  • George, Roshan P., Emory Children's Center, Atlanta, Georgia, United States
  • Barletta, Gina-Marie, Pediatric Kidney Disease & Hypertension Centers , Phoenix, Arizona, United States
  • Belsha, Craig W., Saint Louis University, Saint Louis, Missouri, United States
  • Chaudhuri, Abanti, Stanford University, Stanford, California, United States
  • Goebel, Jens W., Children's Hospital Colorado, Aurora, Colorado, United States
  • Kershaw, David B., University of Michigan, Ann Arbor, Michigan, United States
  • Matossian, Debora, Lurie Children's Hospital, Chicago, Illinois, United States
  • Misurac, Jason, University of Iowa, Iowa City, Iowa, United States
  • Nailescu, Corina, James Whitcomb Riley Hospital For Children, Indianapolis, Indiana, United States
  • Nguyen, Christina R., Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States
  • Pearl, Meghan, Mattel Children's Hospital at UCLA, Los Angeles, California, United States
  • Pollack, Ari, Seattle Children's Hospital, Seattle, Washington, United States
  • Pruette, Cozumel S., Johns Hopkins University, Baltimore, Maryland, United States
  • Singer, Pamela, Cohen Children's Medical Center, New Hyde Park, New York, United States
  • Warady, Bradley A., Children's Mercy Kansas City , Kansas City, Missouri, United States
  • Dahale, Devesh S., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Hooper, David K., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Group or Team Name

  • Improving Renal Outcomes Collaborative

Hypertension is prevalent in 60-90% of pediatric renal transplant recipients. Uncontrolled hypertension contributes to cardiovascular (CV) death and graft loss. Non-standardized blood measure (BP) measurement limits the ability to control hypertension in this population. Here, we report efforts from the Improving Renal Outcomes Collaborative (IROC) to standardize appropriate BP measurement across 16 pediatric kidney transplant centers.


In total, 16 centers participated in structured quality improvement (QI) activities as facilitated by the IROC QI fundamentals course. We prospectively collected clinic BP data from August 2016 to May 2018 and calculated the proportion of visits with appropriate BP measurement according to 5 criteria from published guidelines. For each center, data were analyzed over 2 time periods: a 12-week baseline pre-intervention period and a 20-week post-intervention period. We used run charts to quantify improvements in BP measurement.


We analyzed BP measurement data from 5,242 transplant clinic visits. Prior to IROC interventions, BP was measured appropriately at 10% of visits. Less than 15% of centers were measuring arm circumference, allowing 5 minutes of rest, or averaging 2 manual readings if the initial BP was elevated. Within 10 weeks post-intervention, BP was measured appropriately at 85% of visits. This improvement was sustained for at least 10 weeks (Figure).


Using the infrastructure of the IROC learning health system, we standardized BP measurement across 16 pediatric transplant centers, allowing for more accurate assessment of BP and further interventions to reduce CV risk in pediatric kidney transplant recipients.