Acute Kidney Injury
Conditions
Brief summary
In this trial, patients with acute kidney injury who have recently received a drug that may affect kidney function will be randomized to having an alert placed in the electronic health record or usual care.
Detailed description
Acute kidney injury (AKI) carries a significant, independent risk of mortality among hospitalized patients. Recent studies have demonstrated increased mortality among patients with even small increases in serum creatinine concentration. International guidelines for the treatment of AKI focus on appropriate management of drug dosing, avoiding nephrotoxic exposures, and careful attention to fluid and electrolyte balance. Early nephrologist involvement may also improve outcomes in AKI. Without appropriate provider recognition of AKI, however, none of these measures can be taken, and patient outcomes may suffer. AKI is frequently overlooked by clinicians, but carries a substantial cost, morbidity and mortality burden. Our research group recently conducted a large-scale multicenter randomized controlled trial of electronic alerts for AKI throughout the Yale New Haven Health System from 2018 to 2020. The trial, which enrolled 6,030 patients with AKI, randomized patients between usual care and an intervention group whereby providers received a general AKI alert informing them to the presence of AKI and the patient's recent creatinine trends, and provided a link to an AKI-specific order set. Our study showed that, overall, alerting physicians to the presence of AKI did not demonstrate a difference in the rate of our primary outcome of progression of AKI, dialysis, or death, nor were there any differences in process measures accessed (i.e. provider actions) between the two groups, however, there was substantial heterogeneity among the study sites. Given the highly heterogenous nature of AKI, a more personalized approach may be warranted. Further, this study enrolled all patients who developed AKI rather than a targeted subset of patients who may benefit, such as those AKI patients receiving potentially harmful kidney-toxic medications. In the present proposal, we seek to expand upon our prior study to determine if the use of medication targeted electronic alerts will modify provider behavior, particularly in regards to nephrotoxic medication use and cessation, in the care of hospitalized patients with AKI and/or reduce the rates of progression to AKI, dialysis, or mortality in hospitalized patients. The current study is a randomized, controlled trial of a medication-targeted electronic AKI alert system. Using the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria, inpatients at 4 different teaching hospitals of the Yale New Haven Health System that have had at least one dose of a nephrotoxic agent of interest within 24 hours of AKI onset will be randomized to either usual care or a medication-targeted alert that informs the provider of the presence of AKI and the patient's recent exposures to the targeted classes of medications with an option to discontinue. The primary outcome will be a composite of AKI progression, dialysis, or mortality within 14 days of randomization. Secondary outcomes will focus on the rate of cessation of any medication of interest within 24 hours of randomization and various other best practice metrics.
Interventions
OTHERDrug-specific alert
A drug-specific alert, informing the provider of the presence of AKI as well as recent exposure to a potentially nephrotoxic agent, will be fired.
Sponsors
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Yale University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Acute Kidney Injury based upon the Kidney Disease: Improving Global Outcomes creatinine criteria (a 0.3mg/dl increase over 48 hours or 50% increase over 7 days) and an active order within the past 24 hours to one of the following classes of medications: * Non-steroidal anti-inflammatory drug * Renin Angiotensin Aldosterone System Antagonists * Proton Pump Inhibitors
Exclusion criteria
* Dialysis order prior to AKI onset * Previous randomization * Admission to a hospice service or CMO * First hospital creatinine \>=4.0 mg/dl * ESKD diagnosis code * Kidney transplant within six months prior to randomization
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Patients With Progression of AKI OR Dialysis OR Death | 14 days from Randomization | Progression of AKI is defined by an increase in KDIGO creatinine stage from time of randomization to the present. Dialysis is defined by the receipt of hemodialysis, continuous renal replacement therapy or peritoneal dialysis. Isolated ultrafiltration treatments will not be included. Mortality will be determined from hospital records. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 14- Day Mortality Rate | Assessed from date of randomization to date of death from any cause, within 14 days of randomization | Percentage of patients who expire within 14 days of randomization |
| Inpatient Mortality Rate | Assessed from point of randomization to the date of death from any cause during the end of current index hospitalization, up to 365 days | Percentage of patients who expire during index hospitalization. |
| Percentage of Patients Who Receive Dialysis Within 14 Days of Randomization | Assessed from point of randomization to date of first documented dialysis order, within 14 days of randomization | Receipt of hemodialysis, continuous renal replacement, or peritoneal dialysis within 14 days of randomization |
| Percentage of Patients on Inpatient Dialysis | Assessed from point of randomization to the date of first documented dialysis order during index hospitalization, up to 365 days | Receipt of hemodialysis, continuous renal replacement, or peritoneal dialysis during index hospitalization |
| Percentage of Patients Discharged on Dialysis | Assessed at the point of discharge from index hospitalization, up to 365 days post randomization | Active orders for dialysis at the point of discharge from the index hospitalization |
| Percentage of Patients With AKI Progression From Stage 1 to Stage 2 | Assessed from date of randomization to date of documented AKI progression, within 14 days of randomization | Progression to stage 2 AKI, represented by a doubling of baseline creatinine levels. |
| Percentage of Patients for Whom Any One of the Targeted Medications is Discontinued | Assessed within 24 hours from randomization | The Percentage of patients for whom the targeted agent was discontinued within 24 hours from randomization. For individuals with active orders for more than one targeted agent, cessation of any will be adequate to meet this endpoint. |
| AKI Duration | Assessed from the point of randomization to the point of AKI cessation during index hospitalization, up to 365 days | Time in hours between AKI onset and AKI cessation during index hospitalization |
| Readmission Rate | Within 30 days of index hospitalization discharge | Number of readmissions within 30 days of discharge from index hospitalization |
| Index Hospitalization Cost | Assessed from point of randomization to the date of discharge from index hospitalization, up to 365 days post randomization | Total cost of index hospitalization |
| Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Assessed from 24 hours from randomization up to discharge of index hospitalization | Best practices assessed include: Avoidance of nephrotoxins (cessation of order or absence of de novo order of IV constrast agent, aminoglycoside, NSAID, or ACE inhibitor within 24 hours of randomization), fluid administration (administration of fluids within 24 hours of randomization), urinalysis order (with or without microscopy within 24 hours of randomization), documentation of AKI (by ICD-9 and ICD-10 codes during index hospitalization), monitoring of creatinine (at least one serum creatinine measurement occurring within 36 hours of randomization), documentation of urine output (within 24 hours of randomization), renal consult order during index hospitalization. Each metric above is binary. Outcome is reported as a composite best practice outcome representing the proportion of best practices achieved per subject. |
| Percentage of Subjects With Chart Documentation of AKI | Assessed from time of randomization through to date of index hospitalization discharge, up to 365 days post randomization | Percentage of subjects with chart documentation of AKI by post-discharge ICD-10 codes and by chart adjudication |
| Percentage of Patients With AKI Progression From Stage 2 to Stage 3 | Assessed from date of randomization to date of documented AKI progression, within 14 days of randomization | Progression to stage 3 AKI, represented by a tripling of baseline creatinine levels. |
Countries
United States
Participant flow
Recruitment details
Recruitment and enrollment was done automatically via our best practice alert, which analyzed hospitalized patients for inclusion and exclusion criteria and, if met, automatically enrolled and randomized patients to the usual care or alert group.
Pre-assignment details
5,839 subjects were assessed for eligibility, with 779 excluded due to either the patient's admission dates being prior to the alert becoming active, the first alert firing after a discharge order, or because the patient was already randomized in a previous hospital admission. 5,060 patients were then randomized to alert versus usual care with zero loss to follow up.
Participants by arm
| Arm | Count |
|---|---|
| Usual Care No alert will be fired. | 2,528 |
| Drug-specific Alert A drug-specific AKI alert, including information about the drug of interest as well as the presence of AKI will be fired.
Drug-specific alert: A drug-specific alert, informing the provider of the presence of AKI as well as recent exposure to a potentially nephrotoxic agent, will be fired. | 2,532 |
| Total | 5,060 |
Baseline characteristics
| Characteristic | Usual Care | Total | Drug-specific Alert |
|---|---|---|---|
| Acute Kidney Injury (AKI) stage at randomization Stage 0 | 3 Participants | 9 Participants | 6 Participants |
| Acute Kidney Injury (AKI) stage at randomization Stage 1 | 2248 Participants | 4527 Participants | 2279 Participants |
| Acute Kidney Injury (AKI) stage at randomization Stage 2 | 230 Participants | 421 Participants | 191 Participants |
| Acute Kidney Injury (AKI) stage at randomization Stage 3 | 47 Participants | 103 Participants | 56 Participants |
| Age, Continuous | 70 Years | 70 Years | 70 Years |
| Anion gap | 12 meq/L | 12 meq/L | 12 meq/L |
| Bicarbonate | 23 meq/L | 23 meq/L | 23 meq/L |
| Blood urea nitrogen (BUN) | 29 mg/dL | 29 mg/dL | 29 mg/dL |
| Chloride | 102 meq/L | 102 meq/L | 102 meq/L |
| Comorbidities Chronic Kidney Disease | 616 Participants | 1287 Participants | 671 Participants |
| Comorbidities Chronic Obstructive Pulmonary Disorder (COPD) | 762 Participants | 1538 Participants | 776 Participants |
| Comorbidities Congestive Heart Failure | 784 Participants | 1611 Participants | 827 Participants |
| Comorbidities Depression | 580 Participants | 1181 Participants | 601 Participants |
| Comorbidities Diabetes Mellitus | 928 Participants | 1895 Participants | 967 Participants |
| Comorbidities Hypertension | 1726 Participants | 3436 Participants | 1710 Participants |
| Comorbidities Liver Disease | 359 Participants | 669 Participants | 310 Participants |
| Comorbidities Malignancy | 563 Participants | 1112 Participants | 549 Participants |
| Creatinine at admission | 1.2 mg/dL | 1.2 mg/dL | 1.2 mg/dL |
| Creatinine at randomization | 1.5 mg/dL | 1.5 mg/dL | 1.5 mg/dL |
| Estimated Glomerular Filtration Rate (eGFR) on admission | 61 ml/min/1.73m^2 | 60.3 ml/min/1.73m^2 | 60 ml/min/1.73m^2 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 341 Participants | 691 Participants | 350 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 2163 Participants | 4329 Participants | 2166 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 24 Participants | 40 Participants | 16 Participants |
| Exposures prior to AKI Contrast in prior 72 hours | 662 Participants | 1283 Participants | 621 Participants |
| Exposures prior to AKI (Non-steroidal anti-inflammatory drugs (NSAIDs) | 805 Participants | 1553 Participants | 748 Participants |
| Exposures prior to AKI Patients on one medication of interest (RAASi, NSAID, or PPI) | 1451 Participants | 2921 Participants | 1470 Participants |
| Exposures prior to AKI Patients on three medications of interest (RAASi, NSAID, or PPI) | 173 Participants | 331 Participants | 158 Participants |
| Exposures prior to AKI Patients on two medications of interest (RAASi, NSAID, or PPI) | 904 Participants | 1808 Participants | 904 Participants |
| Exposures prior to AKI (Proton pump inhibitors (PPIs) | 1644 Participants | 3298 Participants | 1654 Participants |
| Exposures prior to AKI Renin angiotensin aldosterone system inhibitors (RAASi) | 1329 Participants | 2679 Participants | 1350 Participants |
| Hemoglobin | 10.6 g/dL | 10.6 g/dL | 10.6 g/dL |
| Hospital Hospital 1 | 1250 Participants | 2447 Participants | 1197 Participants |
| Hospital Hospital 2 | 591 Participants | 1214 Participants | 623 Participants |
| Hospital Hospital 3 | 446 Participants | 910 Participants | 464 Participants |
| Hospital Hospital 4 | 241 Participants | 489 Participants | 248 Participants |
| Hospital Location Emergency Department | 87 Participants | 177 Participants | 90 Participants |
| Hospital Location ICU | 598 Participants | 1158 Participants | 560 Participants |
| Hospital Location Medical Admission | 1924 Participants | 3861 Participants | 1937 Participants |
| Hospital Location Ward | 1746 Participants | 3521 Participants | 1775 Participants |
| Modified SOFA score | 3 Scores on a scale | 2 Scores on a scale | 2 Scores on a scale |
| Platelet count | 214 x1000/uL | 213 x1000/uL | 213 x1000/uL |
| Potassium | 4.2 meq/L | 4.2 meq/L | 4.2 meq/L |
| Race (NIH/OMB) American Indian or Alaska Native | 7 Participants | 18 Participants | 11 Participants |
| Race (NIH/OMB) Asian | 40 Participants | 80 Participants | 40 Participants |
| Race (NIH/OMB) Black or African American | 470 Participants | 968 Participants | 498 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 6 Participants | 5 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 296 Participants | 591 Participants | 295 Participants |
| Race (NIH/OMB) White | 1714 Participants | 3397 Participants | 1683 Participants |
| Sex: Female, Male Female | 1222 Participants | 2453 Participants | 1231 Participants |
| Sex: Female, Male Male | 1306 Participants | 2607 Participants | 1301 Participants |
| Sodium | 138 meq/L | 138 meq/L | 138 meq/L |
| White blood cell count | 9.6 x1000/uL | 9.6 x1000/uL | 9.5 x1000/uL |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 365 / 2,528 | 356 / 2,532 |
| other Total, other adverse events | 0 / 2,528 | 0 / 2,532 |
| serious Total, serious adverse events | 0 / 2,528 | 0 / 2,532 |
Outcome results
Primary
Percentage of Patients With Progression of AKI OR Dialysis OR Death
Progression of AKI is defined by an increase in KDIGO creatinine stage from time of randomization to the present. Dialysis is defined by the receipt of hemodialysis, continuous renal replacement therapy or peritoneal dialysis. Isolated ultrafiltration treatments will not be included. Mortality will be determined from hospital records.
Time frame: 14 days from Randomization
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Percentage of Patients With Progression of AKI OR Dialysis OR Death | 639 Participants |
| Drug-specific Alert | Percentage of Patients With Progression of AKI OR Dialysis OR Death | 585 Participants |
Secondary
14- Day Mortality Rate
Percentage of patients who expire within 14 days of randomization
Time frame: Assessed from date of randomization to date of death from any cause, within 14 days of randomization
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | 14- Day Mortality Rate | 282 Participants |
| Drug-specific Alert | 14- Day Mortality Rate | 253 Participants |
Secondary
AKI Duration
Time in hours between AKI onset and AKI cessation during index hospitalization
Time frame: Assessed from the point of randomization to the point of AKI cessation during index hospitalization, up to 365 days
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Usual Care | AKI Duration | 1.1 days |
| Drug-specific Alert | AKI Duration | 1 days |
Secondary
Index Hospitalization Cost
Total cost of index hospitalization
Time frame: Assessed from point of randomization to the date of discharge from index hospitalization, up to 365 days post randomization
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Usual Care | Index Hospitalization Cost | 27900 dollars |
| Drug-specific Alert | Index Hospitalization Cost | 26900 dollars |
Secondary
Inpatient Mortality Rate
Percentage of patients who expire during index hospitalization.
Time frame: Assessed from point of randomization to the date of death from any cause during the end of current index hospitalization, up to 365 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Inpatient Mortality Rate | 365 Participants |
| Drug-specific Alert | Inpatient Mortality Rate | 356 Participants |
Secondary
Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization
Best practices assessed include: Avoidance of nephrotoxins (cessation of order or absence of de novo order of IV constrast agent, aminoglycoside, NSAID, or ACE inhibitor within 24 hours of randomization), fluid administration (administration of fluids within 24 hours of randomization), urinalysis order (with or without microscopy within 24 hours of randomization), documentation of AKI (by ICD-9 and ICD-10 codes during index hospitalization), monitoring of creatinine (at least one serum creatinine measurement occurring within 36 hours of randomization), documentation of urine output (within 24 hours of randomization), renal consult order during index hospitalization. Each metric above is binary. Outcome is reported as a composite best practice outcome representing the proportion of best practices achieved per subject.
Time frame: Assessed from 24 hours from randomization up to discharge of index hospitalization
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Usual Care | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Contrast administration | 502 Participants |
| Usual Care | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Fluid administration | 1572 Participants |
| Usual Care | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Aminoglycoside administration | 20 Participants |
| Usual Care | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | NSAID administration | 264 Participants |
| Usual Care | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | ACEi administration | 377 Participants |
| Usual Care | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Urinalysis order | 1013 Participants |
| Usual Care | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Documentation of AKI | 956 Participants |
| Usual Care | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Monitoring of creatinine | 2325 Participants |
| Usual Care | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Monitoring of urine output | 2085 Participants |
| Usual Care | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Renal consult | 392 Participants |
| Drug-specific Alert | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Monitoring of creatinine | 2331 Participants |
| Drug-specific Alert | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Contrast administration | 519 Participants |
| Drug-specific Alert | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Urinalysis order | 1024 Participants |
| Drug-specific Alert | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Fluid administration | 1537 Participants |
| Drug-specific Alert | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Renal consult | 393 Participants |
| Drug-specific Alert | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Aminoglycoside administration | 18 Participants |
| Drug-specific Alert | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Documentation of AKI | 1000 Participants |
| Drug-specific Alert | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | NSAID administration | 245 Participants |
| Drug-specific Alert | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | Monitoring of urine output | 2104 Participants |
| Drug-specific Alert | Percentage of AKI Best Practices Achieved Per Subject During Index Hospitalization | ACEi administration | 316 Participants |
Secondary
Percentage of Patients Discharged on Dialysis
Active orders for dialysis at the point of discharge from the index hospitalization
Time frame: Assessed at the point of discharge from index hospitalization, up to 365 days post randomization
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Percentage of Patients Discharged on Dialysis | 105 Participants |
| Drug-specific Alert | Percentage of Patients Discharged on Dialysis | 127 Participants |
Secondary
Percentage of Patients for Whom Any One of the Targeted Medications is Discontinued
The Percentage of patients for whom the targeted agent was discontinued within 24 hours from randomization. For individuals with active orders for more than one targeted agent, cessation of any will be adequate to meet this endpoint.
Time frame: Assessed within 24 hours from randomization
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Percentage of Patients for Whom Any One of the Targeted Medications is Discontinued | 1413 Participants |
| Drug-specific Alert | Percentage of Patients for Whom Any One of the Targeted Medications is Discontinued | 1547 Participants |
Secondary
Percentage of Patients on Inpatient Dialysis
Receipt of hemodialysis, continuous renal replacement, or peritoneal dialysis during index hospitalization
Time frame: Assessed from point of randomization to the date of first documented dialysis order during index hospitalization, up to 365 days
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Percentage of Patients on Inpatient Dialysis | 137 Participants |
| Drug-specific Alert | Percentage of Patients on Inpatient Dialysis | 151 Participants |
Secondary
Percentage of Patients Who Receive Dialysis Within 14 Days of Randomization
Receipt of hemodialysis, continuous renal replacement, or peritoneal dialysis within 14 days of randomization
Time frame: Assessed from point of randomization to date of first documented dialysis order, within 14 days of randomization
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Percentage of Patients Who Receive Dialysis Within 14 Days of Randomization | 127 Participants |
| Drug-specific Alert | Percentage of Patients Who Receive Dialysis Within 14 Days of Randomization | 123 Participants |
Secondary
Percentage of Patients With AKI Progression From Stage 1 to Stage 2
Progression to stage 2 AKI, represented by a doubling of baseline creatinine levels.
Time frame: Assessed from date of randomization to date of documented AKI progression, within 14 days of randomization
Population: Population analyzed represents the number of subjects with AKI Stage 1 upon enrollment.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Percentage of Patients With AKI Progression From Stage 1 to Stage 2 | 248 Participants |
| Drug-specific Alert | Percentage of Patients With AKI Progression From Stage 1 to Stage 2 | 242 Participants |
Secondary
Percentage of Patients With AKI Progression From Stage 2 to Stage 3
Progression to stage 3 AKI, represented by a tripling of baseline creatinine levels.
Time frame: Assessed from date of randomization to date of documented AKI progression, within 14 days of randomization
Population: Analyzed population includes subjects with Stage 1 or Stage 2 AKI upon enrollment.
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Percentage of Patients With AKI Progression From Stage 2 to Stage 3 | 256 Participants |
| Drug-specific Alert | Percentage of Patients With AKI Progression From Stage 2 to Stage 3 | 231 Participants |
Secondary
Percentage of Subjects With Chart Documentation of AKI
Percentage of subjects with chart documentation of AKI by post-discharge ICD-10 codes and by chart adjudication
Time frame: Assessed from time of randomization through to date of index hospitalization discharge, up to 365 days post randomization
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Percentage of Subjects With Chart Documentation of AKI | 956 Participants |
| Drug-specific Alert | Percentage of Subjects With Chart Documentation of AKI | 1000 Participants |
Secondary
Readmission Rate
Number of readmissions within 30 days of discharge from index hospitalization
Time frame: Within 30 days of index hospitalization discharge
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Usual Care | Readmission Rate | 354 Participants |
| Drug-specific Alert | Readmission Rate | 322 Participants |