Acute Kidney Injury, Acute Kidney Injury (AKI)
Conditions
Keywords
Acute kidney injury, AKI, Hospital discharge, Care transitions, Post-discharge care, Patient education, Discharge communication, Discharge summary, Hospital readmission, Chat-based education, Digital health
Brief summary
The goal of this clinical trial is to learn whether different ways of providing information and follow-up support after acute kidney injury, also called AKI, can improve care transitions for adults being discharged from the hospital. AKI is a sudden decrease in kidney function that can occur during a hospital stay. The main questions this study aims to answer are: * Does an AKI discharge summary template improve communication about AKI after hospital discharge? * Does a chat-based educational messaging program improve patient understanding of AKI and support follow-up care after hospital discharge? * Researchers will compare usual care, an AKI discharge summary template, a chat-based educational messaging program, and the combination of the discharge summary template plus chat-based messaging. Researchers will compare four groups: * Usual care * An AKI discharge summary template * A chat-based educational messaging program * Both the AKI discharge summary template and the chat-based educational messaging program Participants will complete questionnaires at the start of the study and about 4 weeks after hospital discharge. Participants will also receive a brief phone call about 3 months after discharge, and the research team will review their medical record for information about follow-up care, lab testing, emergency department visits, and hospital readmissions.
Detailed description
Acute kidney injury, also called AKI, is a common complication during hospitalization and is associated with increased risk of poor outcomes after discharge, including incomplete kidney recovery, medication-related safety concerns, emergency department visits, and hospital readmissions. Despite these risks, information about AKI and recommended follow-up care may not always be communicated clearly to patients or outpatient clinicians during the transition from hospital to home. This pilot randomized clinical trial will evaluate the feasibility and preliminary effects of two care transition strategies for adults hospitalized with AKI. The strategies include an AKI discharge summary template designed to improve communication with outpatient clinicians, and a chat-based educational messaging program designed to provide patients with AKI-related information after discharge. Participants will be assigned to one of four study groups: usual care, the AKI discharge summary template, the chat-based educational messaging program, or both the discharge summary template and chat-based messaging. The study will assess whether these strategies are feasible to deliver and acceptable to participants, and whether they improve patient knowledge, perceived preparedness, communication about AKI, and completion of recommended follow-up care after hospital discharge. Participants will complete study questionnaires and allow the research team to review their medical records for information related to kidney function monitoring, follow-up care, emergency department visits, and hospital readmissions. The results of this pilot study will help inform the design of a larger future trial to improve care transitions for patients recovering from AKI.
Interventions
BEHAVIORALAKI Discharge Summary Template
The AKI discharge summary template provides structured AKI-related information for the hospital discharge summary, including information about the AKI episode and recommended follow-up care. The template is intended to improve communication during the transition from hospital to outpatient care.
BEHAVIORALChat-Based Educational Messaging Program
The chat-based educational messaging program provides AKI-related educational messages after hospital discharge. Messages are delivered through a secure web-based chat-style interface and are designed to support patient understanding of AKI, post-discharge follow-up, and kidney-related care after hospitalization.
Sponsors
Northwell Health
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older * Hospitalized with Stage 2 or Stage 3 acute kidney injury * Kidney function has not returned to baseline at the time of hospital discharge * Able to communicate in English * Able to provide informed consent * Willing and able to participate in study procedures independently or with assistance from a patient-designated care partner
Exclusion criteria
* Acute kidney injury requiring ongoing dialysis at the time of hospital discharge * End-stage kidney disease * Kidney transplant recipient * Currently pregnant * Documented cognitive impairment that precludes informed consent * Receiving hospice or comfort-focused end-of-life care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility: Eligible patient enrollment | Enrollment period | Percentage of eligible patients enrolled among those approached. |
| Feasibility: Participant retention | Baseline to 3 months after discharge | Percentage of enrolled participants who complete the follow-up assessment. |
| Feasibility: Successful delivery of assigned intervention components | Hospital discharge through 4 weeks after discharge | Percentage of participants assigned to an intervention arm who receive the assigned intervention component or components as intended, including the AKI discharge summary template and/or chat-based educational messaging program. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| AKI Knowledge Score | 4 weeks after hospital discharge | Participant AKI knowledge score measured using a study questionnaire. |
| Patient experience during care transitions | 4 weeks after hospital discharge | Patient-reported care transition experience measured using a validated transition-of-care instrument, such as the Care Transitions Measure-15. |
| Self-management behaviors related to kidney health | 4 weeks after hospital discharge | Participant-reported self-management behaviors related to kidney health after hospital discharge, assessed using a study questionnaire. |
| Adherence to outpatient follow-up appointments | 4 weeks after hospital discharge, and 3 months after hospital discharge | Percentage of participants who complete follow-up with a primary care provider or specialist after hospital discharge, assessed by participant report and/or medical record review. |
| Patient-reported discussion of AKI with outpatient provider | 4 weeks after hospital discharge | Percentage of participants who report discussing AKI or kidney-related follow-up needs with an outpatient provider after hospital discharge. |
Contacts
CONTACTJia Hwei Ng, MD, MSCE
CONTACTFarwa Batool, MPH
PRINCIPAL_INVESTIGATORJia Hwei Ng, MD, MSCE
Northwell Health
Outcome results
None listed