title: Reliable individualized monitoring improves cholesterol control in kidney transplant recipients.
abstract: OBJECTIVE
  To develop and evaluate a system for reliable and efficient individualized risk-based monitoring of cholesterol and 11 other tests after kidney transplantation in children.
  
  
  METHODS
  We identified system components that drive reliable individualized monitoring and used quality improvement methods to develop and implement interventions, including (1) monitoring schedules individualized by dyslipidemia risk assigned to each patient, (2) automated previsit decision support from our electronic medical record, (3) standardized work flow and responsibility, and (4) automated forwarding of results to providers. We measured the proportion of patients due for cholesterol testing who had it performed within 1 week of their clinic visit and the proportion of patients in our population who achieved low-density lipoprotein (LDL) cholesterol control at baseline and for 2 years after improved monitoring.
  
  
  RESULTS
  The proportion of visits in which cholesterol monitoring was completed when indicated improved from 80% to 98% within 8 months and was sustained for more than 1 year. The number of patients with controlled LDL (<130 mg/dL, 3.3 mmol/L) improved from 44 (71%) of 62 at the start of our project to 58 (94%) of 62 (P = .002) at an average follow-up of 24 months.
  
  
  CONCLUSIONS
  Using quality improvement and health information technology, we achieved sustained, reliable and efficient personalized monitoring of cholesterol and 11 other tests. This approach enabled substantial improvement in LDL cholesterol control. Structured methods of system redesign that leverage information technology systems hold promise for rapidly achieving reliable individualized care in other settings.
authors.affiliation: Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, MLC 7022, 3333 Burnet Ave, Cincinnati, OH 45229, USA. David.hooper@cchmc.org
authors.forename: David K
authors.initials: DK
authors.lastname: Hooper
authors.forename: Cassie L
authors.initials: CL
authors.lastname: Kirby
authors.forename: Peter A
authors.initials: PA
authors.lastname: Margolis
authors.forename: Jens
authors.initials: J
authors.lastname: Goebel
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood*; D020000:Decision Support Systems, Clinical; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D011182:Postoperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D057285:Precision Medicine; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol