Sustained Improvements After Intervention to Prevent Contrast‐Associated Acute Kidney Injury: A Randomized Controlled Trial
Background In the IMPROVE AKI (A Cluster‐Randomized Trial of Team‐Based Coaching Interventions to Improve Acute Kidney Injury) trial, a combination of team‐based coaching and data‐driven surveillance dashboards reduced the odds of AKI following cardiac catheterization by 46%. The objective of this s...
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Wiley
2025-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.038920 |
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| author | Michael E. Matheny Elizabeth Carpenter‐Song Iben M. Ricket Richard J. Solomon Meagan E. Stabler Sharon E. Davis Lisa Zubkoff Dax M. Westerman Chad Dorn Kevin C. Cox Freneka F. Minter Hani Jneid Jesse W. Currier S. Ahmed Athar Saket Girotra Calvin Leung Thomas J. Helton Ajay Agarwal Mladen I. Vidovich Mary E. Plomondon Stephen W. Waldo Kelly A. Aschbrenner Virginia McKay A. James O'Malley Jeremiah R. Brown |
| author_facet | Michael E. Matheny Elizabeth Carpenter‐Song Iben M. Ricket Richard J. Solomon Meagan E. Stabler Sharon E. Davis Lisa Zubkoff Dax M. Westerman Chad Dorn Kevin C. Cox Freneka F. Minter Hani Jneid Jesse W. Currier S. Ahmed Athar Saket Girotra Calvin Leung Thomas J. Helton Ajay Agarwal Mladen I. Vidovich Mary E. Plomondon Stephen W. Waldo Kelly A. Aschbrenner Virginia McKay A. James O'Malley Jeremiah R. Brown |
| author_sort | Michael E. Matheny |
| collection | DOAJ |
| description | Background In the IMPROVE AKI (A Cluster‐Randomized Trial of Team‐Based Coaching Interventions to Improve Acute Kidney Injury) trial, a combination of team‐based coaching and data‐driven surveillance dashboards reduced the odds of AKI following cardiac catheterization by 46%. The objective of this study was to determine if improvements in AKI outcomes would be sustained after completion of the active intervention. Methods and Results A 2×2 factorial cluster‐randomized trial with an 18‐month active intervention phase (October 2019–March 2021) and an 18‐month sustainability phase (April 2021–September 2022) conducted among cardiac catheterization laboratories in 20 Veterans Affairs sites. Interventions included team‐based coaching in a virtual learning collaborative or technical assistance, with and without access to an automated surveillance reporting dashboard. Data were collected on procedures involving adult patients undergoing diagnostic coronary angiography or percutaneous coronary interventions and not receiving chronic dialysis. The main outcome was AKI within 7 days of cardiac catheterization among all participants and those with preexisting chronic kidney disease. In addition, survey and focused interview data were collected to understand barriers and facilitators to sustaining AKI improvements. In this phase, 440 of 4160 patients experienced AKI, including 216 of 1260 patients with chronic kidney disease. Compared with technical assistance alone, we observed a reduction in AKI among virtual learning collaborative + automated surveillance reporting sites (adjusted odds ratio, 0.60 [95% CI, 0.42–0.86]). Sites had implemented standardized orders (11), oral and intravenous hydration standing orders (13), and contrast limiting protocols (10). Conclusions Team‐based coaching coupled with data‐driven surveillance dashboards reduced AKI by 40% during the 18 months after active participation in the trial. Process improvement education, care process standardization, and automated outcome feedback may be effective and durable methods for reducing AKI. Registration URL: https://clinicaltrials.gov/; Unique Identifier: NCT03556293. |
| format | Article |
| id | doaj-art-b4883182dc024efb8c54c29409c30a29 |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-b4883182dc024efb8c54c29409c30a292025-08-20T03:07:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-05-01141010.1161/JAHA.124.038920Sustained Improvements After Intervention to Prevent Contrast‐Associated Acute Kidney Injury: A Randomized Controlled TrialMichael E. Matheny0Elizabeth Carpenter‐Song1Iben M. Ricket2Richard J. Solomon3Meagan E. Stabler4Sharon E. Davis5Lisa Zubkoff6Dax M. Westerman7Chad Dorn8Kevin C. Cox9Freneka F. Minter10Hani Jneid11Jesse W. Currier12S. Ahmed Athar13Saket Girotra14Calvin Leung15Thomas J. Helton16Ajay Agarwal17Mladen I. Vidovich18Mary E. Plomondon19Stephen W. Waldo20Kelly A. Aschbrenner21Virginia McKay22A. James O'Malley23Jeremiah R. Brown24Department of Biomedical Informatics Vanderbilt University Medical Center Nashville TN USADepartment of Anthropology Dartmouth College Hanover NH USADepartment of Epidemiology Geisel School of Medicine at Dartmouth Hanover NH USAUniversity of Vermont Larner College of Medicine Burlington VT USADepartment of Community and Family Medicine Dartmouth‐Hitchcock Medical Center Lebanon NH USADepartment of Biomedical Informatics Vanderbilt University Medical Center Nashville TN USAUniversity of Alabama at Birmingham and VA Birmingham Health Care Birmingham AL USADepartment of Biomedical Informatics Vanderbilt University Medical Center Nashville TN USADepartment of Biomedical Informatics Vanderbilt University Medical Center Nashville TN USADepartment of Anthropology Dartmouth College Hanover NH USADepartment of Biomedical Informatics Vanderbilt University Medical Center Nashville TN USADivision of Cardiovascular Medicine University of Texas Medical Branch Galveston TX USADivision of Cardiology, Department of Medicine Veteran Affairs Greater Los Angeles Healthcare System Los Angeles CA USACardiology Section Loma Linda VA Medical Center Loma Linda CA USADivision of Cardiology, Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX USADepartment of Medicine, Section of Cardiology Orlando VA Medical Center Orlando FL USAEast Tennessee State University Johnson City TN USAWright State University Dayton VA Medical Center Dayton OH USASection of Cardiology, Jesse Brown VA Medical Center and Department of Medicine University of Illinois at Chicago IL USACART Program VHA Office of Quality and Safety Washington DC USACART Program VHA Office of Quality and Safety Washington DC USADepartment of Anthropology Dartmouth College Hanover NH USAWashington University in St. Louis, MO (V.M.)The Dartmouth Institute for Health Policy and Clinical Practice Lebanon NH USADepartment of Epidemiology Geisel School of Medicine at Dartmouth Hanover NH USABackground In the IMPROVE AKI (A Cluster‐Randomized Trial of Team‐Based Coaching Interventions to Improve Acute Kidney Injury) trial, a combination of team‐based coaching and data‐driven surveillance dashboards reduced the odds of AKI following cardiac catheterization by 46%. The objective of this study was to determine if improvements in AKI outcomes would be sustained after completion of the active intervention. Methods and Results A 2×2 factorial cluster‐randomized trial with an 18‐month active intervention phase (October 2019–March 2021) and an 18‐month sustainability phase (April 2021–September 2022) conducted among cardiac catheterization laboratories in 20 Veterans Affairs sites. Interventions included team‐based coaching in a virtual learning collaborative or technical assistance, with and without access to an automated surveillance reporting dashboard. Data were collected on procedures involving adult patients undergoing diagnostic coronary angiography or percutaneous coronary interventions and not receiving chronic dialysis. The main outcome was AKI within 7 days of cardiac catheterization among all participants and those with preexisting chronic kidney disease. In addition, survey and focused interview data were collected to understand barriers and facilitators to sustaining AKI improvements. In this phase, 440 of 4160 patients experienced AKI, including 216 of 1260 patients with chronic kidney disease. Compared with technical assistance alone, we observed a reduction in AKI among virtual learning collaborative + automated surveillance reporting sites (adjusted odds ratio, 0.60 [95% CI, 0.42–0.86]). Sites had implemented standardized orders (11), oral and intravenous hydration standing orders (13), and contrast limiting protocols (10). Conclusions Team‐based coaching coupled with data‐driven surveillance dashboards reduced AKI by 40% during the 18 months after active participation in the trial. Process improvement education, care process standardization, and automated outcome feedback may be effective and durable methods for reducing AKI. Registration URL: https://clinicaltrials.gov/; Unique Identifier: NCT03556293.https://www.ahajournals.org/doi/10.1161/JAHA.124.038920acute kidney injurychronic kidney diseasecontrast nephropathyprevention |
| spellingShingle | Michael E. Matheny Elizabeth Carpenter‐Song Iben M. Ricket Richard J. Solomon Meagan E. Stabler Sharon E. Davis Lisa Zubkoff Dax M. Westerman Chad Dorn Kevin C. Cox Freneka F. Minter Hani Jneid Jesse W. Currier S. Ahmed Athar Saket Girotra Calvin Leung Thomas J. Helton Ajay Agarwal Mladen I. Vidovich Mary E. Plomondon Stephen W. Waldo Kelly A. Aschbrenner Virginia McKay A. James O'Malley Jeremiah R. Brown Sustained Improvements After Intervention to Prevent Contrast‐Associated Acute Kidney Injury: A Randomized Controlled Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute kidney injury chronic kidney disease contrast nephropathy prevention |
| title | Sustained Improvements After Intervention to Prevent Contrast‐Associated Acute Kidney Injury: A Randomized Controlled Trial |
| title_full | Sustained Improvements After Intervention to Prevent Contrast‐Associated Acute Kidney Injury: A Randomized Controlled Trial |
| title_fullStr | Sustained Improvements After Intervention to Prevent Contrast‐Associated Acute Kidney Injury: A Randomized Controlled Trial |
| title_full_unstemmed | Sustained Improvements After Intervention to Prevent Contrast‐Associated Acute Kidney Injury: A Randomized Controlled Trial |
| title_short | Sustained Improvements After Intervention to Prevent Contrast‐Associated Acute Kidney Injury: A Randomized Controlled Trial |
| title_sort | sustained improvements after intervention to prevent contrast associated acute kidney injury a randomized controlled trial |
| topic | acute kidney injury chronic kidney disease contrast nephropathy prevention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.038920 |
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