Chronic Kidney Disease, End-Stage Renal Disease
Conditions
Keywords
glomerular filtration rate, albuminuria, medical therapy, hospital discharge, hospital readmission, CKD complications, CKD risk factors
Brief summary
Transitional care strategies focused on enhancing the accuracy and comprehensiveness of medication information transfer will lead to improved health outcomes among hospitalized patients with chronic kidney disease.
Detailed description
Patients with CKD and ESRD have more co-morbidities, are hospitalized more often and for longer lengths of stay, and incur greater healthcare costs than patients with other chronic conditions. Enhanced hospital to home transitional care interventions have been shown to improve medication information transfer, reduce hospital readmissions, and slow the progression of declining health in the general population of hospitalized patients. What is not known is the impact enhanced transitional care can have for a very high-risk population, such as those with CKD and ESRD. Interventions that prevent or slow CKD progression, i.e. blood pressure control and intensive glycemic control in patients with diabetes, are all highly dependent on meticulous medication management. For hospitalized patients with CKD or ESRD who are transitioning to home, accurate and comprehensive information transfer is essential to optimal medication management. CKD and ESRD patients are in critical need of improved transitional care that includes accurate and comprehensive medication information transfer. The main objective of this application is to pilot-test the effectiveness of a medication information transfer intervention to improve clinically-relevant outcomes. To this end, the following Specific Aims will be achieved: 1. Evaluate the impact of transitional care interventions on acute care utilization following hospital discharge among patients with CKD or ESRD. 2. Evaluate the impact of transitional care strategies on management of CKD or ESRD management and complications.
Interventions
OTHERMedication Information Transfer Intervention
A pharmacist will visit participants randomized to the intervention group in their homes within 5 days of hospital discharge to administer the 5As Medication Self-Management intervention: Assessment, Advise, Agreement, Assistance, Arrangements.
OTHERUsual care for hospital discharge
Patients will receive medication information according to standard practice for discharge of hospitalized patients.
Sponsors
Washington State University
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Health Sciences & Services Authority of Spokane County
Providence Sacred Heart Medical Center & Children's Hospital
Providence Medical Research Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
No
Inclusion criteria
for CKD arm: 1. Hospitalized patients 2. \> 21 years of age 3. Diagnosis of CKD stages 3-5, not treated by dialysis Inclusion Criteria for ESRD arm: 1. Hospitalized patients 2. \> 21 years of age 3. Patients treated with hemodialysis or peritoneal dialysis
Exclusion criteria
1\. Kidney Transplant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| acute care utilization | 90 days | Acute care utilization defined by emergency department visits and hospitalizations in the first 30 and 90 days after discharge from the index hospitalization. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| CKD status, risk factors and complications | 30 and 90 days | blood pressure, eGFR, urine albumin/creatinine ratio, fasting glucose, HbA1c (in the diabetic subgroup), lipids, hemoglobin, phosphorus, PTH, serum potassium. |
| ESRD status, risk factors and complications: | 30 and 90 days | blood pressure, fasting glucose,HbA1c (in the diabetic subgroup), lipids, hemoglobin, phosphorus, PTH, serum potassium |
Countries
United States
Outcome results
None listed