Abstract: PUB253
Feasibility of a Pharmacist-Embedded Transitions of Care Model to Increase Guideline-Based Care for Hospitalized Patients with Diabetic Kidney Disease
Session Information
Category: CKD (Non-Dialysis)
- 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Di Palo, Katherine E., Montefiore Health System Inc, New York, New York, United States
- Garcia, Danielle, Montefiore Health System Inc, New York, New York, United States
- Kumar, Neelja D., Montefiore Health System Inc, New York, New York, United States
- Stark, Allison, Montefiore Health System Inc, New York, New York, United States
- Nealy, Elyza, Montefiore Health System Inc, New York, New York, United States
- Golestaneh, Ladan, Yale School of Medicine, New Haven, Connecticut, United States
Background
Embedding a clinical pharmacist within transitions of care (TOC) may bridge the guideline adherence gap for hospitalized patients with diabetic kidney disease (DKD).
Methods
We conducted a feasibility study at Montefiore Hospital (Bronx, NY) from 9/24 to 12/25. An electronic health record (EHR) dashboard identified hospitalized adults using objective criteria: diabetes, eGFR <60 mL_min_1.73m2, or proteinuria >30 mg/g. Enrolled participants received a bedside pharmacist consult prior to discharge and telephonic follow-up at 2 and 14 days post-discharge. We assessed: (1) dashboard accuracy and (2) enrollment yield (target 100 in 1 year).
Results
The dashboard identified 642 patients; 189 (29.4%) met eligibility and 86 (45.5% of eligible) were enrolled. Among 453 deemed ineligible, 10 (2.2%) reflected dashboard misclassification and the remainder were excluded by pre-specified protocol criteria (Figure 1). Among eligible non-enrollees, top reasons were patient refusal (47.6%) and discharge before meeting study coordinator (30.1%). All 86 enrolled patients completed the bedside pharmacist consult; 72 (83.7%) were reached at 2 days and 56 (65.1%) at 14 days post-discharge (Table 1).
Conclusion
The EHR dashboard identified DKD patients with 98.4% accuracy but enrollment fell short of target due to protocol exclusions and patient refusal rather than infrastructure barriers.
Enrolled Participants (n=86)
| Age (median, IQR) | 73(66,77) |
| Female (n,%) | 43(50) |
| Race (n,%) | |
| Black or African American | 41(48) |
| White | 16 (19) |
| Asian | 2(2) |
| Other | 27(31) |
| Hispanic or Latino Ethnicity (n,%) | 30(35) |
| Presumptive cause of kidney disease (n,%) | |
| Diabetes | 42(49) |
| Hypertension | 13(15) |
| Uknown | 28(33) |
Funding
- Other NIH Support