Team-Based Coaching Intervention to Improve Contrast-Associated Acute Kidney Injury

作者：Jeremiah R. Brown, Richard Solomon, Meagan E. Stabler, Sharon E. Davis, Elizabeth Carpenter–Song, Lisa Zubkoff, Dax Westerman, Chad Dorn, Kevin C. Cox, Freneka Minter, Hani Jneid, Jesse W. Currier, S. Ahmed Athar, Saket Girotra, Calvin Leung, Thomas Helton, Ajay Agarwal, Mladen I. Vidovich, Mary E. Plomondon, Stephen W. Waldo, Kelly A. Aschbrenner, A. James O’Malley, Michael E. Matheny · 发表于：Clinical Journal of the American Society of Nephrology · 年份：2023 · DOI：10.2215/cjn.0000000000000067 · 被引用次数：9 · 研究领域：Acute Kidney Injury Research、Trauma, Hemostasis, Coagulopathy, Resuscitation、Chronic Kidney Disease and Diabetes

BACKGROUND: Up to 14% of patients in the United States undergoing cardiac catheterization each year experience AKI. Consistent use of risk minimization preventive strategies may improve outcomes. We hypothesized that team-based coaching in a Virtual Learning Collaborative (Collaborative) would reduce postprocedural AKI compared with Technical Assistance (Assistance), both with and without Automated Surveillance Reporting (Surveillance). METHODS: The IMPROVE AKI trial was a 2×2 factorial cluster-randomized trial across 20 Veterans Affairs medical centers (VAMCs). Participating VAMCs received Assistance, Assistance with Surveillance, Collaborative, or Collaborative with Surveillance for 18 months to implement AKI prevention strategies. The Assistance and Collaborative approaches promoted hydration and limited NPO and contrast dye dosing. We fit logistic regression models for AKI with site-level random effects accounting for the clustering of patients within medical centers with a prespecified interest in exploring differences across the four intervention arms. RESULTS: Among VAMCs' 4517 patients, 510 experienced AKI (235 AKI events among 1314 patients with preexisting CKD). AKI events in each intervention cluster were 110 (13%) in Assistance, 122 (11%) in Assistance with Surveillance, 190 (13%) in Collaborative, and 88 (8%) in Collaborative with Surveillance. Compared with sites receiving Assistance alone, case-mix-adjusted differences in AKI event proportions were -3% (95% con...