Alicia M Neu1, Troy Richardson2, Heidi Gruhler De Souza2, Allison Redpath Mahon3, Mahima Keswani4, Joshua Zaritsky5, Raj Munshi6, Sarah Swartz7, Christine B Sethna8, Michael J G Somers9, Bradley A Warady10. 1. Johns Hopkins University School of Medicine, 200 N Wolfe Street, Room 3065, Baltimore, MD, 21287, USA. aneu1@jhmi.edu. 2. The Children's Hospital Association, Lenexa, KS, USA. 3. University of Wisconsin American Family Children's Hospital, Madison, WI, USA. 4. Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA. 5. Nemours AI Dupont Hospital for Children, Wilmington, DE, USA. 6. Seattle Children's Hospital, Seattle, WA, USA. 7. Texas Children's Hospital, Houston, TX, USA. 8. Cohen Children's Medical Center, New York, NY, USA. 9. Boston Children's Hospital, Boston, MA, USA. 10. Children's Mercy Kansas City, Kansas City, MO, USA.
Abstract
BACKGROUND: In its first 3 years, the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative demonstrated a statistically significant increase in the likelihood of compliance with a standardized follow-up care bundle and a significant reduction in peritonitis. We sought to determine if compliance with care bundles and low peritonitis rates could be sustained in centers continuously participating for 84 months. METHODS: Centers that participated from collaborative launch through the 84-month study period and provided pre-launch peritonitis rates were included. Children on maintenance peritoneal dialysis were eligible for enrollment. Changes in bundle compliance were assessed using a logistic regression model or a generalized linear mixed model (GLMM). Changes in average annualized peritonitis rates over time were modeled using GLMMs. RESULTS: Nineteen centers contributed 1055 patients with 1268 catheters and 17,247 follow-up encounters. The likelihood of follow-up compliance increased significantly over the study period (OR 1.05 95% confidence interval (CI) 1.03, 1.07; p < 0.001). Centers achieved ≥ 80% follow-up bundle compliance by 28 months and maintained a mean compliance of 84% between 28 and 84 months post-launch. Average monthly peritonitis rates decreased from 0.53 (95% CI 0.37, 0.70) infections per patient-year pre-launch to 0.30 (95% CI 0.23, 0.43) at 84 months post-launch, p < 0.001. CONCLUSIONS: Centers participating in the SCOPE Collaborative for 84 months achieved and maintained a high level of compliance with a standardized follow-up care bundle and demonstrated a significant and continued reduction in average monthly peritonitis rates.
BACKGROUND: In its first 3 years, the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative demonstrated a statistically significant increase in the likelihood of compliance with a standardized follow-up care bundle and a significant reduction in peritonitis. We sought to determine if compliance with care bundles and low peritonitis rates could be sustained in centers continuously participating for 84 months. METHODS: Centers that participated from collaborative launch through the 84-month study period and provided pre-launch peritonitis rates were included. Children on maintenance peritoneal dialysis were eligible for enrollment. Changes in bundle compliance were assessed using a logistic regression model or a generalized linear mixed model (GLMM). Changes in average annualized peritonitis rates over time were modeled using GLMMs. RESULTS: Nineteen centers contributed 1055 patients with 1268 catheters and 17,247 follow-up encounters. The likelihood of follow-up compliance increased significantly over the study period (OR 1.05 95% confidence interval (CI) 1.03, 1.07; p < 0.001). Centers achieved ≥ 80% follow-up bundle compliance by 28 months and maintained a mean compliance of 84% between 28 and 84 months post-launch. Average monthly peritonitis rates decreased from 0.53 (95% CI 0.37, 0.70) infections per patient-year pre-launch to 0.30 (95% CI 0.23, 0.43) at 84 months post-launch, p < 0.001. CONCLUSIONS: Centers participating in the SCOPE Collaborative for 84 months achieved and maintained a high level of compliance with a standardized follow-up care bundle and demonstrated a significant and continued reduction in average monthly peritonitis rates.
Authors: Christine B Sethna; Kristina Bryant; Raj Munshi; Bradley A Warady; Troy Richardson; John Lawlor; Jason G Newland; Alicia Neu Journal: Clin J Am Soc Nephrol Date: 2016-06-23 Impact factor: 8.237