title: Evaluation of a collaborative chronic care approach to improve outcomes in kidney transplant recipients.
abstract: Several studies found that renal transplant recipients with chronic kidney disease have untreated complications and do not attain recommended clinical targets. Using a before/after design with propensity score-matched controls, we evaluated whether an advanced practice nurse-led interprofessional collaborative chronic care approach could improve clinical outcomes for CKD transplant patients compared with a traditional physician-led model. The intervention included strategies for disease self-management, shared decision making, and healthcare system reorganization. The primary outcome was the proportion of patients attaining at least seven of nine targets as per published guidelines. A greater proportion of intervention patients achieved the outcome (68% vs. 10%; p = 0.0001) and had discussions about end-stage treatment options (88% vs. 13%; p = 0.0001) compared with controls. The intervention patients had significantly fewer emergency room visits (incidence rate ratio [IRR] 0.53; 95% CI 0.29-0.91; p = 0.02) and hospital admissions (IRR 0.34; 95% CI 0.16-0.68; p = 0.001) compared with the control patients. There were no significant differences found between the groups in systolic/diastolic blood pressure, carbon dioxide, hemoglobin, or phosphate parameters. An advanced practice nurse-led approach, based on the chronic care model, has the potential to improve clinical outcomes for renal transplant recipients and needs to be tested in a multicenter randomized controlled trial.
authors: Division of Nephrology, Renal Transplant Program, The Ottawa Hospital, Ottawa, ON, Canada. jabissonnette@ottawahospital.on.ca
authors: J
authors: J
authors: Bissonnette
authors: K
authors: K
authors: Woodend
authors: B
authors: B
authors: Davies
authors: D
authors: D
authors: Stacey
authors: G A
authors: GA
authors: Knoll
mesh_terms: D000328:Adult; D057179:Advanced Practice Nursing; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D011182:Postoperative Care / Q000379:methods* / Q000592:standards; D057216:Propensity Score; D058996:Quality Improvement / Q000458:organization & administration*; D051436:Renal Insufficiency, Chronic / Q000601:surgery*; D016896:Treatment Outcome