title: Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention.
abstract: BACKGROUND
  Contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity and mortality after percutaneous coronary interventions and is a patient safety objective of the National Quality Forum. However, no formal quality improvement program to prevent CI-AKI has been conducted. Therefore, we sought to determine whether a 6-year regional multicenter quality improvement intervention could reduce CI-AKI after percutaneous coronary interventions.
  
  
  RESULTS
  We conducted a prospective multicenter quality improvement study to prevent CI-AKI (serum creatinine increase ≥0.3 mg/dL within 48 hours or ≥50% during hospitalization) among 21 067 nonemergent patients undergoing percutaneous coronary interventions at 10 hospitals between 2007 and 2012. Six intervention hospitals participated in the quality improvement intervention. Two hospitals with significantly lower baseline rates of CI-AKI, which served as benchmark sites and were used to develop the intervention, and 2 hospitals not receiving the intervention were used as controls. Using time series analysis and multilevel poisson regression clustering to the hospital level, we calculated adjusted risk ratios for CI-AKI comparing the intervention period to baseline. Adjusted rates of CI-AKI were significantly reduced in hospitals receiving the intervention by 21% (risk ratio, 0.79; 95% confidence interval: 0.67-0.93; P=0.005) for all patients and by 28% in patients with baseline estimated glomerular filtration rate <60 mL/min per 1.73 m(2) (risk ratio, 0.72; 95% confidence interval: 0.56-0.91; P=0.007). Benchmark hospitals had no significant changes in CI-AKI. Key qualitative system factors associated with improvement included multidisciplinary teams, limiting contrast volume, standardized fluid orders, intravenous fluid bolus, and patient education about oral hydration.
  
  
  CONCLUSIONS
  Simple cost-effective quality improvement interventions can prevent ≤1 in 5 CI-AKI events in patients with undergoing nonemergent percutaneous coronary interventions.
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.). jbrown@dartmouth.edu.
authors: Jeremiah R
authors: JR
authors: Brown
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Richard J
authors: RJ
authors: Solomon
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Mark J
authors: MJ
authors: Sarnak
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Peter A
authors: PA
authors: McCullough
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Mark E
authors: ME
authors: Splaine
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Louise
authors: L
authors: Davies
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Cathy S
authors: CS
authors: Ross
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Harold L
authors: HL
authors: Dauerman
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Janette L
authors: JL
authors: Stender
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Sheila M
authors: SM
authors: Conley
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: John F
authors: JF
authors: Robb
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Kristine
authors: K
authors: Chaisson
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Richard
authors: R
authors: Boss
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Peggy
authors: P
authors: Lambert
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: David J
authors: DJ
authors: Goldberg
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Deborah
authors: D
authors: Lucier
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Frank A
authors: FA
authors: Fedele
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Mirle A
authors: MA
authors: Kellett
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Susan
authors: S
authors: Horton
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: William J
authors: WJ
authors: Phillips
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Cynthia
authors: C
authors: Downs
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Alan
authors: A
authors: Wiseman
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: Todd A
authors: TA
authors: MacKenzie
authors: From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.).
authors: David J
authors: DJ
authors: Malenka
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000517:prevention & control*; D000368:Aged; D019985:Benchmarking / Q000379:methods*; D003287:Contrast Media / Q000009:adverse effects / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D058996:Quality Improvement; D012041:Regional Medical Programs; D015532:Rehydration Solutions / Q000008:administration & dosage*
chemical_list: D003287:Contrast Media; D015532:Rehydration Solutions; D003404:Creatinine
keywords: acute kidney injury; contrast media; percutaneous coronary intervention; quality improvement