Abstract: FR-PO113
A Self-Funded, Value-Based, Post-AKI Care Program: Predicted vs. Observed Outcomes
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Solanki, Kaushal V., Geisinger Health, Danville, Pennsylvania, United States
- Gotschal, Dolly Ann, Geisinger Health, Danville, Pennsylvania, United States
- Chang, Alexander R., Geisinger Health, Danville, Pennsylvania, United States
- Norfolk, Evan, Geisinger Health, Danville, Pennsylvania, United States
- Singh, Gurmukteshwar, Geisinger Health, Danville, Pennsylvania, United States
Background
Readmissions occur in 20% patients with Acute Kidney Injury (AKI), adding $20000 in healthcare costs. While post-AKI care improves outcomes,studies are limited to non-dialysis referred patients. As one of the earliest post-AKI clinics,we set up a self-sustaining multi-disciplinary post-AKI care program.
Methods
Target population/interventions were finalized by interviewing nephrologists,patients and AKI!Now Workgroup. Since May 2022,hospitalized adults with high-risk stage 2/3 AKI at Geisinger Medical Center were identified in real-time. Those eligible were provided inpatient AKI education, nurse coordinator services, flexible scheduling, non-face-to-face care and expedited nephrology visits. Follow-up was up to 90 days post-discharge. Observed vs Predicted (Grampian-Aberdeen model) 90-day rehospitalization/mortality risk were compared.
Results
On screening 1198 patients,303 were eligible; 195 (64.4%, 5% on dialysis) were enrolled (Fig 1) and 154 have completed 90 days. More than 95% received direct or non-face-to-face nephrology care. Fig 2 shows predicted vs observed outcomes: 90-day rehospitalization/mortality was 30.2% vs a mean risk of 45.8%. Graphical pattern suggests steady benefit lending itself to a Difference-in-Difference estimation.
Conclusion
We developed a value-based comprehensive post-AKI care model showing improvement over predicted outcomes. Our approach allows quasi-experimental analysis and could be widely applicable.
Figure 2