Kidney Week

Abstract: PUB040

Implementing the AKI in Care Transitions Program: A Mixed-Methods Study

Session Information

• Publication Only

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• May, Heather P., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Heather P. May, MSc, PharmD

• Ledet, Caroline B., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Caroline B. Ledet, MD

• Griffin, Joan M., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Joan M. Griffin, PhD

• Kashani, Kianoush, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Kianoush Kashani, MD, MS, FASN

• Kattah, Andrea G., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Andrea G. Kattah, MD, MS

• Mccoy, Rozalina G., University of Maryland School of Medicine, Baltimore, Maryland, United States

Rozalina G. Mccoy, MD, MS

• Rule, Andrew D., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Andrew D. Rule, MD, MS, FASN

• Tinaglia, Angeliki G., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Angeliki G. Tinaglia

• Barreto, Erin F., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Erin F. Barreto, PharmD, MS, FASN

Group or Team Name

• ACT Study Group.

Background

The AKI in Care Transitions (ACT) Program was designed to address barriers to post-AKI care delivery by promoting follow-up with primary care. In a clinical trial comparing ACT to usual care, mixed methods were used to assess the feasibility and acceptability of ACT implementation among health care staff and trial participants.

Methods

The study included health care staff who delivered ACT and trial participants who were adults with stage 3 AKI during hospitalization and discharged home without dialysis needs. Patients randomized to the ACT group received kidney health education before discharge and coordination of post-discharge laboratory and clinician (primary care physician, pharmacist) follow-up within 14 days. ACT implementation was evaluated using surveys and interviews, which were coded to identify themes.

Results

Feasibility and acceptability of ACT were high among all participants (Figure 1). However, qualitative data revealed implementation considerations that could threaten future scale and spread. Scheduling was complex, requiring coordinated efforts from care team members from multiple departments. Clinicians perceived that engaging more frequently with ACT patients improved their comfort level with the workflow and opinions on sustainability and reduced the perceived burden of ACT. Many patients and clinicians felt ACT was more valuable in the presence of chronic kidney disease or incomplete AKI recovery at discharge, relative to other patients.

Conclusion

Primary care-based transitions of care for AKI survivors represents a feasible solution to the gaps identified in post-AKI care. Post-AKI care delivery models are likely to meet implementation challenges related to the diffusivity of AKI across practice settings and patients’ and clinicians’ knowledge and perceived value of post-AKI care.

Funding

• Other NIH Support