Reducing Contrast-Induced Acute Kidney Injury Using a Regional Multicenter Quality Improvement Intervention

作者：Jeremiah R. Brown, Richard Solomon, Mark J. Sarnak, Peter A. McCullough, Mark E. Splaine, Louise Davies, Cathy S. Ross, Harold L. Dauerman, Janette L. Stender, Sheila M. Conley, John F. Robb, Kristine Chaisson, Richard Boss, P. Lambert, David Goldberg, Deborah Lucier, Frank A Fedele, Mirle A. Kellett, Susan R. Horton, William J. Phillips, Cynthia Downs, Alan Wiseman, Todd A. MacKenzie, David J. Malenka · 发表于：Circulation Cardiovascular Quality and Outcomes · 年份：2014 · DOI：10.1161/circoutcomes.114.000903 · 被引用次数：64 · 研究领域：Acute Kidney Injury Research、Trauma, Hemostasis, Coagulopathy, Resuscitation、Sepsis Diagnosis and Treatment

BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity and mortality after percutaneous coronary interventions and is a patient safety objective of the National Quality Forum. However, no formal quality improvement program to prevent CI-AKI has been conducted. Therefore, we sought to determine whether a 6-year regional multicenter quality improvement intervention could reduce CI-AKI after percutaneous coronary interventions. METHODS AND RESULTS: We conducted a prospective multicenter quality improvement study to prevent CI-AKI (serum creatinine increase ≥0.3 mg/dL within 48 hours or ≥50% during hospitalization) among 21 067 nonemergent patients undergoing percutaneous coronary interventions at 10 hospitals between 2007 and 2012. Six intervention hospitals participated in the quality improvement intervention. Two hospitals with significantly lower baseline rates of CI-AKI, which served as benchmark sites and were used to develop the intervention, and 2 hospitals not receiving the intervention were used as controls. Using time series analysis and multilevel poisson regression clustering to the hospital level, we calculated adjusted risk ratios for CI-AKI comparing the intervention period to baseline. Adjusted rates of CI-AKI were significantly reduced in hospitals receiving the intervention by 21% (risk ratio, 0.79; 95% confidence interval: 0.67-0.93; P=0.005) for all patients and by 28% in patients with baseline estimated glomerular fi...