title: Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis.
abstract: The Standardizing Care to improve Outcomes in Pediatric End stage renal disease (SCOPE) Collaborative aims to reduce peritonitis rates in pediatric chronic peritoneal dialysis patients by increasing implementation of standardized care practices. To assess this, monthly care bundle compliance and annualized monthly peritonitis rates were evaluated from 24 SCOPE centers that were participating at collaborative launch and that provided peritonitis rates for the 13 months prior to launch. Changes in bundle compliance were assessed using either a logistic regression model or a generalized linear mixed model. Changes in average annualized peritonitis rates over time were illustrated using the latter model. In the first 36 months of the collaborative, 644 patients with 7977 follow-up encounters were included. The likelihood of compliance with follow-up care practices increased significantly (odds ratio 1.15, 95% confidence interval 1.10, 1.19). Mean monthly peritonitis rates significantly decreased from 0.63 episodes per patient year (95% confidence interval 0.43, 0.92) prelaunch to 0.42 (95% confidence interval 0.31, 0.57) at 36 months postlaunch. A sensitivity analysis confirmed that as mean follow-up compliance increased, peritonitis rates decreased, reaching statistical significance at 80% at which point the prelaunch rate was 42% higher than the rate in the months following achievement of 80% compliance. In its first 3 years, the SCOPE Collaborative has increased the implementation of standardized follow-up care and demonstrated a significant reduction in average monthly peritonitis rates.
authors.affiliation: Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: aneu1@jhmi.edu.
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Neu
authors.affiliation: The Children's Hospital Association, Alexandria, Virginia, USA, and Overland Park, Kansas, USA.
authors.forename: Troy
authors.initials: T
authors.lastname: Richardson
authors.affiliation: The Children's Hospital Association, Alexandria, Virginia, USA, and Overland Park, Kansas, USA.
authors.forename: John
authors.initials: J
authors.lastname: Lawlor
authors.affiliation: The Children's Hospital Association, Alexandria, Virginia, USA, and Overland Park, Kansas, USA.
authors.forename: Jayne
authors.initials: J
authors.lastname: Stuart
authors.affiliation: Divisions of Pediatric Nephrology and Infectious Diseases, Children's Mercy Hospital, Kansas City, Missouri, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Newland
authors.affiliation: Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: McAfee
authors.affiliation: Divisions of Pediatric Nephrology and Infectious Diseases, Children's Mercy Hospital, Kansas City, Missouri, USA.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
mesh_terms: D000293:Adolescent; D000359:Aftercare / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D016017:Odds Ratio; D064872:Patient Care Bundles / Q000592:standards*; D010349:Patient Compliance; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000592:standards*; D010538:Peritonitis / Q000453:epidemiology* / Q000209:etiology; D058996:Quality Improvement / Q000592:standards
keywords: pediatric nephrology; peritoneal dialysis; peritonitis