Evaluation of a collaborative chronic care approach to improve outcomes in kidney transplant recipients

• Published in: Clinical transplantation 2013-03, Vol.27 (2), p.232-238
• Main Authors: Bissonnette, J., Woodend, K., Davies, B., Stacey, D., Knoll, G. A.
• Format: Article
• Language: English
• Subjects: Adult; advanced practice nurse; Advanced Practice Nursing; Aged; Biological and medical sciences; chronic care; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Health participants; Humans; interprofessional; Kidney Transplantation; Male; Matched-Pair Analysis; Medical sciences; Middle Aged; Patient Care Team - organization & administration; Patient-Centered Care - organization & administration; Postoperative Care - methods; Postoperative Care - standards; Propensity Score; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Improvement - organization & administration; Renal Insufficiency, Chronic - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.12068

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.