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Abstract: SA-OR01

IMPROVE AKI: Sustainability of Team-Based Coaching Interventions to Improve AKI in a Cluster-Randomized Trial

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Matheny, Michael Edwin, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Solomon, Richard J., University of Vermont Medical Center, Burlington, Vermont, United States
  • Davis, Sharon E., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Cox, Kevin C., Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, United States
  • Stabler, Meagan E., Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, United States
  • Westerman, Dax, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Dorn, Chad A., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • O'Malley, James, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, United States
  • Brown, Jeremiah R., Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, United States
Background

Up to 14% who undergo cardiac catheterization procedures in the U.S. each year may experience acute kidney injury (AKI). An absence of standards for implementing known interventions hinders efforts to prevent AKI. In a 2x2 factorial cluster-randomized trial, we found the combination of team-based coaching and a data-driven surveillance dashboard reduced the odds of AKI by 46%. We hypothesized these improvements would persist in the period following the active intervention phase of the trial.

Methods

A 2x2 factorial cluster-randomized trial was conducted that randomized 20 Veteran Affairs hospitals to receive team-based coaching in a Virtual Learning Collaborative (VLC) compared to Technical Assistance with an AKI Prevention Toolkit (TA), both with and without Automated Surveillance Reporting (VLC+ASR and TA+ASR). Patient outcomes were collected over 18 months following the active intervention phase. Multilevel logistic models for AKI were fit with site-level random effects to account for the clustered design.

Results

Across 20 randomized sites, 440 of 4,160 patients experienced AKI during 18-months following the active intervention phase, including 216 of 1,260 patients with pre-existing chronic kidney disease (CKD). We observed a substantial reduction in AKI within the VLC+ASR cluster compared to the TA cluster (aOR=0.60; 0.42-0.86) consistent with the effect previously reported for the active intervention phase (aOR=0.54; 0.40-0.74).

Conclusion

Team-based coaching along with a data-driven surveillance dashboard can sustainably reduce AKI by 40%, even after active participation in the trial is complete. These combined interventions are an effective, scalable framework to establish aggressive AKI prevention protocols.

The following patient features were included for adjustment: age, race, tobacco use, anemia, heart failure, CKD, diabetes, hypertension, and prior percutaneous coronary intervention.

Funding

  • NIDDK Support