Etienne Macedo1, Azra Bihorac2, Edward D Siew3, Paul M Palevsky4, John A Kellum5, Claudio Ronco6, Ravindra L Mehta7, Mitchell H Rosner8, Michael Haase9, Kianoush B Kashani10, Erin F Barreto11. 1. Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, United States. Electronic address: emmacedo@ucsd.edu. 2. Division of Nephrology, Hypertension & Renal Transplantation, Department of Medicine, University of Florida, Gainesville, FL, United States. 3. Tennessee Valley Healthcare System (TVHS), Veterans Administration (VA) Medical Center, Veteran's Health Administration; Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center; Vanderbilt Center for Kidney Disease (VCKD), Nashville, TN, United States. 4. Renal Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. 5. Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, PA, United States. 6. University of Padova. Director Department of Nephrology Dialysis & Transplantation; AULSS8 Regione Veneto, Vicenza, Italy; Director International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy. 7. Division of Nephrology and Hypertension, Department of Medicine, University of California San Diego, San Diego, CA, United States. 8. Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia. 9. Medical Faculty, Otto-von Guericke University Magdeburg, Magdeburg, Germany; MVZ Diaverum, Potsdam, Germany. 10. Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States. 11. Department of Pharmacy; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.
Abstract
BACKGROUND: Acute kidney injury (AKI) is independently associated with increased morbidity and mortality. Quality improvement has been identified as an important goal in the care of patients with AKI. Different settings can be targeted to improve AKI care, broadly classified these include the inpatient and outpatient environments. In this paper, we will emphasize quality indicators associated with the management and secondary prevention of AKI in hospitalized patients to limit the severity, duration, and complications. METHODS: During the 22nd Acute Disease Quality Initiative (ADQI) consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations for AKI-related quality indicators (QIs) and care processes to improve patient outcomes. The management and secondary prevention of AKI in hospitalized patients were discussed, and recommendations were summarized. RESULTS: The first step in optimizing the quality of AKI management is the determination of baseline performance. Data regarding each institution's/center's performance can provide a reference point from which to benchmark quality efforts. Quality program initiatives should prioritize achievable goals likely to have the highest impact according to the setting and context. Key AKI quality metrics should include improvement in timely recognition, appropriate diagnostic workup, and implementation of known interventions that limit progression and severity, facilitating recovery, and mitigating AKI-associated complications. We propose the Recognition-Action-Results framework to plan, measure, and report the progress toward improving AKI management quality. CONCLUSIONS: These recommendations identified and outlined an approach to define and evaluate the quality of AKI management in hospitalized patients.
BACKGROUND:Acute kidney injury (AKI) is independently associated with increased morbidity and mortality. Quality improvement has been identified as an important goal in the care of patients with AKI. Different settings can be targeted to improve AKI care, broadly classified these include the inpatient and outpatient environments. In this paper, we will emphasize quality indicators associated with the management and secondary prevention of AKI in hospitalized patients to limit the severity, duration, and complications. METHODS: During the 22nd Acute Disease Quality Initiative (ADQI) consensus conference, a multidisciplinary group of experts discussed the evidence and used a modified Delphi process to achieve consensus on recommendations for AKI-related quality indicators (QIs) and care processes to improve patient outcomes. The management and secondary prevention of AKI in hospitalized patients were discussed, and recommendations were summarized. RESULTS: The first step in optimizing the quality of AKI management is the determination of baseline performance. Data regarding each institution's/center's performance can provide a reference point from which to benchmark quality efforts. Quality program initiatives should prioritize achievable goals likely to have the highest impact according to the setting and context. Key AKI quality metrics should include improvement in timely recognition, appropriate diagnostic workup, and implementation of known interventions that limit progression and severity, facilitating recovery, and mitigating AKI-associated complications. We propose the Recognition-Action-Results framework to plan, measure, and report the progress toward improving AKI management quality. CONCLUSIONS: These recommendations identified and outlined an approach to define and evaluate the quality of AKI management in hospitalized patients.
Authors: Jennifer S McDonald; Robert J McDonald; Eric E Williamson; David F Kallmes; Kianoush Kashani Journal: Intensive Care Med Date: 2017-02-17 Impact factor: 17.440
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Authors: Moritz Schanz; Christoph Wasser; Sebastian Allgaeuer; Severin Schricker; Juergen Dippon; Mark Dominik Alscher; Martin Kimmel Journal: Nephrol Dial Transplant Date: 2019-11-01 Impact factor: 5.992
Authors: Kianoush Kashani; Mitchell Howard Rosner; Michael Haase; Andrew J P Lewington; Donal J O'Donoghue; F Perry Wilson; Mitra K Nadim; Samuel A Silver; Alexander Zarbock; Marlies Ostermann; Ravindra L Mehta; Sandra L Kane-Gill; Xiaoqiang Ding; Peter Pickkers; Azra Bihorac; Edward D Siew; Erin F Barreto; Etienne Macedo; John A Kellum; Paul M Palevsky; Ashita Jiwat Tolwani; Claudio Ronco; Luis A Juncos; Oleksa G Rewa; Sean M Bagshaw; Theresa Ann Mottes; Jay L Koyner; Kathleen D Liu; Lui G Forni; Michael Heung; Vin-Cent Wu Journal: Clin J Am Soc Nephrol Date: 2019-05-17 Impact factor: 8.237