Implementation of a Digitally Enabled Care Pathway (Part 1): Impact on Clinical Outcomes and Associated Health Care Costs
| Autor: | Stephen Morris, Gareth Jones, Mustafa Suleyman, Charles Merrick, Omid Sadeghi-Alavijeh, Cian Hughes, Chris Laing, Trevor Back, Mary Emerson, Sarah Stanley, Rosalind Raine, Jennifer Cross, Claire Nightingale, Peter Martin, Alistair Connell, Hugh Montgomery, Dominic King, Estela Capelas Barbosa, Kareem Ayoub, Alan Karthikesalingam, Geraint Rees |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Nephrology medicine.medical_specialty medicine.medical_treatment nephrology 030232 urology & nephrology Health Informatics HN 03 medical and health sciences 0302 clinical medicine RA0421 Interquartile range Internal medicine Intensive care Health care medicine Humans 030212 general & internal medicine Renal replacement therapy Original Paper business.industry Acute kidney injury Odds ratio medicine.disease Triage Telemedicine Treatment Outcome acute kidney injury Emergency medicine Female business Delivery of Health Care RC |
| Zdroj: | Journal of Medical Internet Research Connell, A, Raine, R, Martin, P, Capelas Barbosa, E, Morris, S, Nightingale, C, Sadeghi-Alavijeh, O, King, D, Karthikesalingam, A, Hughes, C, Back, T, Ayoub, K, Suleyman, M, Jones, G, Cross, J, Stanley, S, Emerson, M, Merrick, C, Rees, G, Montgomery, H & Laing, C 2019, ' Implementation of a Digitally Enabled Care Pathway (Part 1) : Impact on Clinical Outcomes and Associated Health Care Costs ', Journal of Medical Internet Research, vol. 21, no. 7, e13147 . https://doi.org/10.2196/13147 |
| ISSN: | 1438-8871 |
| Popis: | Background The development of acute kidney injury (AKI) in hospitalized patients is associated with adverse outcomes and increased health care costs. Simple automated e-alerts indicating its presence do not appear to improve outcomes, perhaps because of a lack of explicitly defined integration with a clinical response. Objective We sought to test this hypothesis by evaluating the impact of a digitally enabled intervention on clinical outcomes and health care costs associated with AKI in hospitalized patients. Methods We developed a care pathway comprising automated AKI detection, mobile clinician notification, in-app triage, and a protocolized specialist clinical response. We evaluated its impact by comparing data from pre- and postimplementation phases (May 2016 to January 2017 and May to September 2017, respectively) at the intervention site and another site not receiving the intervention. Clinical outcomes were analyzed using segmented regression analysis. The primary outcome was recovery of renal function to ≤120% of baseline by hospital discharge. Secondary clinical outcomes were mortality within 30 days of alert, progression of AKI stage, transfer to renal/intensive care units, hospital re-admission within 30 days of discharge, dependence on renal replacement therapy 30 days after discharge, and hospital-wide cardiac arrest rate. Time taken for specialist review of AKI alerts was measured. Impact on health care costs as defined by Patient-Level Information and Costing System data was evaluated using difference-in-differences (DID) analysis. Results The median time to AKI alert review by a specialist was 14.0 min (interquartile range 1.0-60.0 min). There was no impact on the primary outcome (estimated odds ratio [OR] 1.00, 95% CI 0.58-1.71; P=.99). Although the hospital-wide cardiac arrest rate fell significantly at the intervention site (OR 0.55, 95% CI 0.38-0.76; P Conclusions The digitally enabled clinical intervention to detect and treat AKI in hospitalized patients reduced health care costs and possibly reduced cardiac arrest rates. Its impact on other clinical outcomes and identification of the active components of the pathway requires clarification through evaluation across multiple sites. |
| Databáze: | OpenAIRE |
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