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Kidney Week

Abstract: SA-PO542

AKI Outcomes as a Quality Paradigm: A Health Systems Approach

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Gudsoorkar, Prakash Shashikant, University of Cincinnati, Cincinnati, Ohio, United States
  • Modi, Jwalant R., University of Cincinnati, Cincinnati, Ohio, United States
  • Meganathan, Karthikeyan, University of Cincinnati, Cincinnati, Ohio, United States
  • Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background

Acute kidney injury (AKI) affects 1-in-3 hospitalized patients; survivors face long-term consequences including high risk of re-admissions, end-stage renal disease (ESRD), or mortality. Retrospective studies estimate that only 15-20% of patients receive follow-up renal care within one year of discharge. At a large tertiary care health system, we operationalized and implemented a quality improvement program (QIP) to track discharge disposition and post-discharge follow-up renal care of all AKI consults.

Methods

By combining billing data and health-system wide informatics, we considered all non-ESRD, non-transplant hospitalizations receiving renal consults for each calendar quarter. The first hospitalization with an AKI renal consult in each quarter was considered as the index event. Discharge dispositions included expired/hospice, inter-facility transfers (long-term acute care/acute care), home with self-care or home-health, nursing home, and others. All survivors except inter-facility transfers were considered eligible for renal follow-up metric defined as any renal contact within 90-days of discharge (office visits, chronic dialysis visits, or renal follow-up during readmission). We also tracked all-cause 90-day re-admissions. Chi-square and Kruskal-Wallis test was used for comparison across quarters.

Results

Between 10/2015 and 12/2017 (9 quarters) we identified 2,383 AKI consults (60% male, 64% White). Overall, 22% expired/discharged to hospice (18% to 25% across quarters; p = 0.70); 12% inter-facility transfers; and 66% were eligible for renal follow-up metric (23% home with self-care; 18% home with home-care; 23% rehab-nursing home; 2% others). Of the eligible patients, 42% met the metric (range from 39% to 49% across quarters p=0.09); renal office visits occurred in 29% (range across quarters 22% to 37%), with a median time to renal visit of 31 days (q1, q3, 18, 49). Overall 90-day re-admission rate was 40% (range 35 to 46% across quarters; p=0.29), with median time to re-admission of 17 days (q1, q3, 7, 42).

Conclusion

This is the first report of operationalizing system-wide AKI metrics in real-time and can inform optimal strategies to improve post-discharge care in AKI. Such informatics-based QIP have the potential to plan and implement targeted resource allocation and improve patient and process outcomes.

Funding

  • Clinical Revenue Support