The Improving Renal Outcomes Collaborative: Blood Pressure Measurement in Transplant Recipients.
Journal
Pediatrics
ISSN: 1098-4275
Titre abrégé: Pediatrics
Pays: United States
ID NLM: 0376422
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
accepted:
11
03
2020
pubmed:
11
6
2020
medline:
26
8
2020
entrez:
11
6
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32518170
pii: peds.2019-2833
doi: 10.1542/peds.2019-2833
pmc: PMC7329257
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIDDK NIH HHS
ID : K08 DK111998
Pays : United States
Organisme : NIDDK NIH HHS
ID : K23 DK101690
Pays : United States
Informations de copyright
Copyright © 2020 by the American Academy of Pediatrics.
Déclaration de conflit d'intérêts
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
Références
Kidney Int. 2015 Mar;87(3):575-83
pubmed: 25317931
J Pediatr. 2002 Aug;141(2):191-7
pubmed: 12183713
Nephrol Dial Transplant. 2012 Aug;27(8):3359-68
pubmed: 22328733
Qual Saf Health Care. 2003 Dec;12(6):458-64
pubmed: 14645763
Pediatrics. 2013 Aug;132(2):e349-55
pubmed: 23821694
JAMA. 2013 May 8;309(18):1921-9
pubmed: 23645144
J Pediatr. 2003 Jul;143(1):98-103
pubmed: 12915832
Am J Transplant. 2013 Apr;13(4):839-850
pubmed: 23432992
Intern Med J. 2004 May;34(5):290-1
pubmed: 15151677
Pediatrics. 2012 Oct;130(4):604-10
pubmed: 22987883
Am Heart J. 2013 Aug;166(2):373-380.e2
pubmed: 23895822
N Engl J Med. 2014 Aug 7;371(6):549-58
pubmed: 25099579
Lancet. 2014 May 24;383(9931):1831-43
pubmed: 24856028
Clin J Am Soc Nephrol. 2018 Mar 7;13(3):422-428
pubmed: 29440119
Transplantation. 2004 Mar 27;77(6):849-53
pubmed: 15077025
Pediatr Clin North Am. 2019 Feb;66(1):269-280
pubmed: 30454748
J Am Soc Nephrol. 2012 Apr;23(4):578-85
pubmed: 22383696
Pediatr Transplant. 2004 Aug;8(4):394-9
pubmed: 15265168
Clin Pediatr (Phila). 2015 Jun;54(7):667-75
pubmed: 25416626
Pediatrics. 2004 Aug;114(2 Suppl 4th Report):555-76
pubmed: 15286277
Pediatrics. 2007 Mar;119(3):e538-43
pubmed: 17332173
N Engl J Med. 2004 Sep 23;351(13):1296-305
pubmed: 15385656
Pediatr Transplant. 2011 Sep;15(6):635-41
pubmed: 21884348
J Am Soc Nephrol. 2015 Jun;26(6):1248-60
pubmed: 25653099
Transplantation. 2017 Jan;101(1):150-156
pubmed: 26895218
Pediatrics. 2018 Jul;142(1):
pubmed: 29899043
Pediatr Nephrol. 2016 Oct;31(10):1593-604
pubmed: 26482251
Fam Pract. 2005 Apr;22(2):168-9
pubmed: 15772116
Pediatrics. 2010 Jun;125(6):e1286-93
pubmed: 20439598
Hypertension. 2008 Oct;52(4):631-7
pubmed: 18725579
Pediatrics. 2018 Sep;142(3):
pubmed: 30177515