Michael E Seifert1, Devesh S Dahale2, Margret Kamel3, Pamela D Winterberg3, Gina-Marie Barletta4, Craig W Belsha5, Abanti Chaudhuri6, Joseph T Flynn7, Rouba Garro3, Roshan P George3, Jens W Goebel8, David B Kershaw9, Debora Matossian10, Jason Misurac11, Corina Nailescu12, Christina R Nguyen13, Meghan Pearl14, Ari Pollack7, Cozumel S Pruette15, Pamela Singer16, Judith S VanSickle17, Priya Verghese18, Bradley A Warady17, Andrew Warmin2, Patricia L Weng14, Larysa Wickman9, Amy C Wilson11, David K Hooper19. 1. Department of Pediatrics, University of Alabama and Children's of Alabama, Birmingham, Alabama. 2. Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio. 3. Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia. 4. Phoenix Children's Hospital, Phoenix, Arizona. 5. Department of Pediatrics, Saint Louis University, St Louis, Missouri. 6. Department of Pediatrics, Stanford University, Stanford, California. 7. Seattle Children's Hospital, Seattle, Washington. 8. Children's Hospital Colorado, Aurora, Colorado. 9. Department of Pediatrics, University of Michigan, Ann Arbor, Michigan. 10. Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. 11. Department of Pediatrics, University of Iowa, Iowa City, Iowa. 12. Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana. 13. Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 14. Mattel Children's Hospital, University of California Los Angeles Health, Los Angeles, California. 15. Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland. 16. Cohen Children's Medical Center, New Hyde Park, New York. 17. Children's Mercy Hospital, Kansas City, Missouri; and. 18. Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota. 19. Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio; david.hooper@cchmc.org.
Abstract
BACKGROUND AND OBJECTIVES: Hypertension is highly prevalent in pediatric kidney transplant recipients and contributes to cardiovascular death and graft loss. Improper blood pressure (BP) measurement limits the ability to control hypertension in this population. Here, we report multicenter efforts from the Improving Renal Outcomes Collaborative (IROC) to standardize and improve appropriate BP measurement in transplant patients. METHODS: Seventeen centers participated in structured quality improvement activities facilitated by IROC, including formal training in quality improvement methods. The primary outcome measure was the proportion of transplant clinic visits with appropriate BP measurement according to published guidelines. Prospective data were analyzed over a 12-week pre-intervention period and a 20-week active intervention period for each center and then aggregated as of the program-specific start date. We used control charts to quantify improvements across IROC centers. We applied thematic analysis to identify patterns and common themes of successful interventions. RESULTS: We analyzed data from 5392 clinic visits. At baseline, BP was measured and documented appropriately at 11% of visits. Center-specific interventions for improving BP measurement included educating clinic staff, assigning specific team member roles, and creating BP tracking tools and alerts. Appropriate BP measurement improved throughout the 20-week active intervention period to 78% of visits. CONCLUSIONS: We standardized appropriate BP measurement across 17 pediatric transplant centers using the infrastructure of the IROC learning health system and substantially improved the rate of appropriate measurement over 20 weeks. Accurate BP assessment will allow further interventions to reduce complications of hypertension in pediatric kidney transplant recipients.
BACKGROUND AND OBJECTIVES:Hypertension is highly prevalent in pediatric kidney transplant recipients and contributes to cardiovascular death and graft loss. Improper blood pressure (BP) measurement limits the ability to control hypertension in this population. Here, we report multicenter efforts from the Improving Renal Outcomes Collaborative (IROC) to standardize and improve appropriate BP measurement in transplant patients. METHODS: Seventeen centers participated in structured quality improvement activities facilitated by IROC, including formal training in quality improvement methods. The primary outcome measure was the proportion of transplant clinic visits with appropriate BP measurement according to published guidelines. Prospective data were analyzed over a 12-week pre-intervention period and a 20-week active intervention period for each center and then aggregated as of the program-specific start date. We used control charts to quantify improvements across IROC centers. We applied thematic analysis to identify patterns and common themes of successful interventions. RESULTS: We analyzed data from 5392 clinic visits. At baseline, BP was measured and documented appropriately at 11% of visits. Center-specific interventions for improving BP measurement included educating clinic staff, assigning specific team member roles, and creating BP tracking tools and alerts. Appropriate BP measurement improved throughout the 20-week active intervention period to 78% of visits. CONCLUSIONS: We standardized appropriate BP measurement across 17 pediatric transplant centers using the infrastructure of the IROC learning health system and substantially improved the rate of appropriate measurement over 20 weeks. Accurate BP assessment will allow further interventions to reduce complications of hypertension in pediatric kidney transplant recipients.
Authors: Matthew F Daley; Alan R Sinaiko; Liza M Reifler; Heather M Tavel; Jason M Glanz; Karen L Margolis; Emily Parker; Nicole K Trower; Malini Chandra; Nancy E Sherwood; Kenneth Adams; Elyse O Kharbanda; Louise C Greenspan; Joan C Lo; Patrick J O'Connor; David J Magid Journal: Pediatrics Date: 2013-07-01 Impact factor: 7.124
Authors: Daniel J Shapiro; Adam L Hersh; Michael D Cabana; Scott M Sutherland; Anisha I Patel Journal: Pediatrics Date: 2012-09-17 Impact factor: 7.124