Implementation of a Digitally Enabled Care Pathway (Part 1): Impact on Clinical Outcomes and Associated Health Care Costs

Journal of Medical Internet Research
Alistair ConnellChristopher Laing

Abstract

The development of acute kidney injury (AKI) in hospitalized patients is associated with adverse outcomes and increased health care costs. Simple automated e-alerts indicating its presence do not appear to improve outcomes, perhaps because of a lack of explicitly defined integration with a clinical response. We sought to test this hypothesis by evaluating the impact of a digitally enabled intervention on clinical outcomes and health care costs associated with AKI in hospitalized patients. We developed a care pathway comprising automated AKI detection, mobile clinician notification, in-app triage, and a protocolized specialist clinical response. We evaluated its impact by comparing data from pre- and postimplementation phases (May 2016 to January 2017 and May to September 2017, respectively) at the intervention site and another site not receiving the intervention. Clinical outcomes were analyzed using segmented regression analysis. The primary outcome was recovery of renal function to ≤120% of baseline by hospital discharge. Secondary clinical outcomes were mortality within 30 days of alert, progression of AKI stage, transfer to renal/intensive care units, hospital re-admission within 30 days of discharge, dependence on renal re...Continue Reading

References

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Oct 28, 2011·BMC Medical Research Methodology·Guy N BrockJohn Myers
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Oct 16, 2014·Kidney International·Mark E ThomasMarlies Ostermann
May 1, 2015·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Simon SawhneyCorri Black
Dec 2, 2015·Clinical Medicine : Journal of the Royal College of Physicians of London·Alistair Connell, Chris Laing
Nov 2, 2016·Nephron·Nicholas M SelbyUNKNOWN Tackling AKI Investigators
Jan 16, 2017·Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association·Philippe LachanceSean M Bagshaw
May 19, 2017·QJM : Monthly Journal of the Association of Physicians·T ChandrasekarK A Abraham
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Sep 5, 2017·International Journal of Clinical Practice·Dafydd PhillipsUNKNOWN Welsh AKI steering group
Nov 4, 2017·Journal of the American Society of Nephrology : JASN·Mohammed Al-JaghbeerJohn A Kellum

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Citations

Nov 8, 2019·Cardiovascular Research·Stefan M Kallenberger, Constanze Schmidt
Sep 3, 2020·Journal of Telemedicine and Telecare·Christina MelianMichael C Wyatt

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Software Mentioned

PLICS
Streams app
R
NHSEDA
TACKLING
Streams
AKORDD
Stata MP

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