Over two million people in the United States undergo cardiac catheterization each year. While the procedure is used effectively for both diagnostic and interventional purposes, it is not without risk: Acute kidney injury (AKI) occurs in up to 14 percent of all patients following a cardiac catheterization and up to 50 percent in patients with pre-existing kidney disease. When AKI occurs, patients have an increased risk of cardiovascular events, prolonged hospitalization, end-stage renal disease, and even death. A research team led by Dartmouth Institute Associate Professor Jeremiah Brown, PhD, MS, recently was awarded a $3.5 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases to test preventative interventions through a virtual learning collaborative with or without automated surveillance reporting (ASR).
"We know there are widely accepted interventions--ones that our group and others have contributed to--that can help prevent AKI in patients undergoing cardiac catheterization. The problem is that these interventions are rarely implemented," Brown says. "So, the critical research question is not what hospitals should do but how to get them to do it."
Brown says previous work by the team, which was funded by the Agency for Healthcare Research and Quality, has demonstrated the feasibility and potential effectiveness of virtual learning collaboratives to increase the use of AKI prevention protocols: In an earlier 10-hospital pilot trial, use of an AKI prevention toolkit comprised of three core preventative interventions led to a 28 percent reduction in AKI. The team's previous work--funded by the Department of Veterans Affairs--also has demonstrated the potential effectiveness of ASR which provides near real-time feedback to frontline care workers.
Twenty hospitals throughout the country have agreed to participate in the cluster-randomized trial. Each hospital will receive one of the following interventions for 18 months: technical assistance, technical assistance with ASR, virtual learning collaborative with team-based coaching, and virtual learning collaborative with ASR. Each hospital site will receive the AKI prevention toolkit. The group, which includes researchers from the Vanderbilt University School of Medicine and The University of Vermont Larner College of Medicine, hypothesizes that clinical teams in a virtual learning collaborative will reduce incidence of AKI following procedures compared to technical assistance intervention--both with or without ASR.
The hospitals will continue to enroll patients following the 18-month intervention period for an additional 18 months post-intervention with technical assistance, automated surveillance reporting, and virtual learning collaborative interventions removed, so that the team can evaluate whether the reduced incidence of AKI will be sustained for each of the randomized clusters during the post-intervention phase.
"We think that this trial not only has the potential to improve the quality of care for the over two million people annually undergoing cardiac catheterizations, but that the findings could help hospitals implement a wide array of preventative interventions that could dramatically improve patient care and outcomes. Our findings could also reduce healthcare expenditures from AKI complications which cost the U.S. health system $1.2 billion annually," Brown says.