Investments in Primary Care Research for 2021 and 2022

This grant funded the implementation of a pilot feasibility trial evaluating a program that supports patients discharged from the hospital to home after an episode of acute kidney injury. The program is designed to improve patient kidney health, knowledge, and safety, while filling gaps in care and improving quality.

Study Overview

Problem: Survivors of acute kidney injury (AKI) are at increased risk of re-hospitalization and poor health, due in part to gaps in the kidney-focused care and education provided during their care transition after discharge from the hospital.

Main Objective: To evaluate the Acute Kidney Injury in Care Transitions (ACT) program, a new care model for patients to improve quality, outcomes, and experiences of the care provided to AKI survivors after discharge from the hospital.

Approach: The research team is conducting a pilot feasibility clinical trial to determine the feasibility and acceptability of the ACT program and the preliminary efficacy of ACT on clinical and patient-reported outcomes. Outcomes include hospital readmissions, recurrent episodes of AKI, and kidney function after discharge, as well as quality of life. The intervention uses electronic indicators to identify AKI survivors, then connects them with nurse educators and care coordinators prior to discharge from the hospital, and a follow-up visit with a clinician and pharmacist within 14 days after discharge. Feasibility and acceptability are assessed with mixed methods to evaluate the perspectives of patients and clinicians.

Results: Early results published from this study show that patients and clinicians find the ACT intervention to be feasible and scalable, and that it addresses gaps in care for AKI survivors. Multidisciplinary care teams are able to extend the capacity for monitoring kidney health among AKI survivors.^1,2 Findings on the program's impact on clinical and patient-reported outcomes are forthcoming.

Primary Care Relevance

In a primary care setting, these data could assist clinicians with providing more high-quality, well- coordinated, and patient-centered care for survivors of AKI. The multidisciplinary approach which involves nurses and pharmacists alongside physicians and advanced practice providers appears feasible and is an attractive way to leverage the expertise of the entire care team.³

AHRQ Primary Care Priority Area

Research on management of clinical areas unique to primary care, such as multiple chronic conditions, preventive care, undifferentiated syndromes, or behavioral and mental healthcare that is integrated within primary care.

Notes

1. Barreto EF, Schreier DJ, May HP, Mara KC, Chamberlain AM, Kashani KB, et al. Incidence of Serum Creatinine Monitoring and Outpatient Visit Follow-Up among Acute Kidney Injury Survivors after Discharge: A Population-Based Cohort Study. Am J Nephrol. 2021;52(10-11):817-26.
2. Schreier DJ, Rule AD, Kashani KB, Mara KC, Kane-Gill SL, Lieske JC, et al. Nephrotoxin Exposure in the 3 Years following Hospital Discharge Predicts Development or Worsening of Chronic Kidney Disease among Acute Kidney Injury Survivors. Am J Nephrol. 2022;53(4):273-81.
3. Barreto EF, May HP, Schreier DJ, Meade LA, Anderson BK, Rensing ME, Ruud KL, Kattah AG, Rule AD, McCoy RG, Finnie DM, Herges JR, Kashani KB; ACT Study Group. Development and Feasibility of a Multidisciplinary Approach to AKI Survivorship in Care Transitions: Research Letter. Can J Kidney Health Dis. 2022 Mar 6;9:20543581221081258.