Mariam Charkviani , Andrea G. Kattah , Andrew D. Rule , Jennifer A. Ferguson , Kristin C. Mara , Kianoush B. Kashani , Heather P. May , Jordan K. Rosedahl , Swetha Reddy , Lindsey M. Philpot , Erin F. Barreto
{"title":"急性肾损伤幸存者远程患者监护：单个中心的经验与效果评估","authors":"Mariam Charkviani , Andrea G. Kattah , Andrew D. Rule , Jennifer A. Ferguson , Kristin C. Mara , Kianoush B. Kashani , Heather P. May , Jordan K. Rosedahl , Swetha Reddy , Lindsey M. Philpot , Erin F. Barreto","doi":"10.1016/j.xkme.2024.100905","DOIUrl":null,"url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Remote patient monitoring (RPM) could improve the quality and efficiency of acute kidney injury (AKI) survivor care. This study described our experience with AKI RPM and characterized its effectiveness.</div></div><div><h3>Study Design</h3><div>A cohort study matched 1:3 to historical controls.</div></div><div><h3>Setting & Participants</h3><div>Patients hospitalized with an episode of AKI who were discharged home and were not treated with dialysis.</div></div><div><h3>Exposure</h3><div>Participation in an AKI RPM program, which included use of a home vital sign and symptom monitoring technology and weekly in-center laboratory assessments.</div></div><div><h3>Outcomes</h3><div>Risk of unplanned hospital readmission or emergency department (ED) visit within 6 months.</div></div><div><h3>Analytic Approach</h3><div>Endpoints were assessed using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Forty of the 49 patients enrolled in AKI RPM (82%) participated in the program after hospital discharge. Seventy three percent of patients experienced one AKI RPM alert, most commonly related to fluid status. Among those with stage 3 AKI, the risk of unplanned readmission or ED visit within 6 months of discharge was not different between AKI RPM patients (n<!--> <!-->=<!--> <!-->34) and matched controls (n<!--> <!-->=<!--> <!-->102) (HR 1.33 [95% CI, 0.81-2.18]; <em>P</em> <!-->=<!--> <!-->0.27). The incidence of an ED visit without hospitalization was significantly higher in the AKI RPM group (HR 1.95, [95% CI, 1.05-3.62]; <em>P</em> <!-->=<!--> <!-->0.035). The risk of an unplanned readmission or ED visit was higher in those with baseline eGFR<!--> <!--><<!--> <!-->45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> exposed to AKI RPM (HR 2.24 [95% CI, 1.19-4.20]; <em>P</em> <!-->=<!--> <!-->0.012) when compared with those with baseline eGFR<!--> <!-->≥45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> (HR 0.69 [95% CI, 0.29-1.67]; <em>P</em> <!-->=<!--> <!-->0.41) (test of interaction <em>P</em> <!-->=<!--> <!-->0.04).</div></div><div><h3>Limitations</h3><div>Small sample size that may have been underpowered for the effectiveness endpoints.</div></div><div><h3>Conclusions</h3><div>AKI RPM, when used after hospital discharge, led to alerts and interventions directed at optimizing kidney health and AKI complications but did not reduce the risk for rehospitalization.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Acute Kidney Injury Survivor Remote Patient Monitoring: A Single Center’s Experience and an Effectiveness Evaluation\",\"authors\":\"Mariam Charkviani , Andrea G. Kattah , Andrew D. Rule , Jennifer A. Ferguson , Kristin C. Mara , Kianoush B. Kashani , Heather P. May , Jordan K. Rosedahl , Swetha Reddy , Lindsey M. Philpot , Erin F. Barreto\",\"doi\":\"10.1016/j.xkme.2024.100905\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Rationale & Objective</h3><div>Remote patient monitoring (RPM) could improve the quality and efficiency of acute kidney injury (AKI) survivor care. This study described our experience with AKI RPM and characterized its effectiveness.</div></div><div><h3>Study Design</h3><div>A cohort study matched 1:3 to historical controls.</div></div><div><h3>Setting & Participants</h3><div>Patients hospitalized with an episode of AKI who were discharged home and were not treated with dialysis.</div></div><div><h3>Exposure</h3><div>Participation in an AKI RPM program, which included use of a home vital sign and symptom monitoring technology and weekly in-center laboratory assessments.</div></div><div><h3>Outcomes</h3><div>Risk of unplanned hospital readmission or emergency department (ED) visit within 6 months.</div></div><div><h3>Analytic Approach</h3><div>Endpoints were assessed using Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Forty of the 49 patients enrolled in AKI RPM (82%) participated in the program after hospital discharge. Seventy three percent of patients experienced one AKI RPM alert, most commonly related to fluid status. Among those with stage 3 AKI, the risk of unplanned readmission or ED visit within 6 months of discharge was not different between AKI RPM patients (n<!--> <!-->=<!--> <!-->34) and matched controls (n<!--> <!-->=<!--> <!-->102) (HR 1.33 [95% CI, 0.81-2.18]; <em>P</em> <!-->=<!--> <!-->0.27). The incidence of an ED visit without hospitalization was significantly higher in the AKI RPM group (HR 1.95, [95% CI, 1.05-3.62]; <em>P</em> <!-->=<!--> <!-->0.035). The risk of an unplanned readmission or ED visit was higher in those with baseline eGFR<!--> <!--><<!--> <!-->45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> exposed to AKI RPM (HR 2.24 [95% CI, 1.19-4.20]; <em>P</em> <!-->=<!--> <!-->0.012) when compared with those with baseline eGFR<!--> <!-->≥45<!--> <!-->mL/min/1.73<!--> <!-->m<sup>2</sup> (HR 0.69 [95% CI, 0.29-1.67]; <em>P</em> <!-->=<!--> <!-->0.41) (test of interaction <em>P</em> <!-->=<!--> <!-->0.04).</div></div><div><h3>Limitations</h3><div>Small sample size that may have been underpowered for the effectiveness endpoints.</div></div><div><h3>Conclusions</h3><div>AKI RPM, when used after hospital discharge, led to alerts and interventions directed at optimizing kidney health and AKI complications but did not reduce the risk for rehospitalization.</div></div>\",\"PeriodicalId\":17885,\"journal\":{\"name\":\"Kidney Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Kidney Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S259005952400116X\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kidney Medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S259005952400116X","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
理论依据& 目标远程患者监护（RPM）可提高急性肾损伤（AKI）幸存者护理的质量和效率。本研究介绍了我们在 AKI RPM 方面的经验，并描述了其有效性。研究设计一项队列研究，与历史对照组进行 1:3 匹配。结果6个月内发生意外再入院或急诊科就诊的风险。分析方法采用Cox比例危险模型评估终点。结果49名参加AKI RPM的患者中有40人（82%）在出院后参加了该项目。73%的患者经历过一次 AKI RPM 警报，最常见的警报与液体状态有关。在 3 期 AKI 患者中，AKI RPM 患者（34 人）与匹配对照组（102 人）在出院后 6 个月内发生意外再入院或急诊就诊的风险没有差异（HR 1.33 [95% CI, 0.81-2.18]；P = 0.27）。AKI RPM 组未住院的急诊就诊发生率明显更高（HR 1.95 [95% CI, 1.05-3.62]；P = 0.035）。与基线 eGFR ≥45 mL/min/1.73 m2 的患者相比（HR 0.69 [95% CI, 0.29-1.67]; P = 0.41），接受 AKI RPM 治疗的基线 eGFR ≥45 mL/min/1.73 m2 患者发生意外再入院或急诊就诊的风险更高（HR 2.24 [95% CI, 1.19-4.20]; P = 0.012）（交互作用检验 P = 0.04）。结论出院后使用AKI RPM可发出警报并采取干预措施，以优化肾脏健康和AKI并发症，但并不能降低再次住院的风险。
Acute Kidney Injury Survivor Remote Patient Monitoring: A Single Center’s Experience and an Effectiveness Evaluation
Rationale & Objective
Remote patient monitoring (RPM) could improve the quality and efficiency of acute kidney injury (AKI) survivor care. This study described our experience with AKI RPM and characterized its effectiveness.
Study Design
A cohort study matched 1:3 to historical controls.
Setting & Participants
Patients hospitalized with an episode of AKI who were discharged home and were not treated with dialysis.
Exposure
Participation in an AKI RPM program, which included use of a home vital sign and symptom monitoring technology and weekly in-center laboratory assessments.
Outcomes
Risk of unplanned hospital readmission or emergency department (ED) visit within 6 months.
Analytic Approach
Endpoints were assessed using Cox proportional hazards models.
Results
Forty of the 49 patients enrolled in AKI RPM (82%) participated in the program after hospital discharge. Seventy three percent of patients experienced one AKI RPM alert, most commonly related to fluid status. Among those with stage 3 AKI, the risk of unplanned readmission or ED visit within 6 months of discharge was not different between AKI RPM patients (n = 34) and matched controls (n = 102) (HR 1.33 [95% CI, 0.81-2.18]; P = 0.27). The incidence of an ED visit without hospitalization was significantly higher in the AKI RPM group (HR 1.95, [95% CI, 1.05-3.62]; P = 0.035). The risk of an unplanned readmission or ED visit was higher in those with baseline eGFR < 45 mL/min/1.73 m2 exposed to AKI RPM (HR 2.24 [95% CI, 1.19-4.20]; P = 0.012) when compared with those with baseline eGFR ≥45 mL/min/1.73 m2 (HR 0.69 [95% CI, 0.29-1.67]; P = 0.41) (test of interaction P = 0.04).
Limitations
Small sample size that may have been underpowered for the effectiveness endpoints.
Conclusions
AKI RPM, when used after hospital discharge, led to alerts and interventions directed at optimizing kidney health and AKI complications but did not reduce the risk for rehospitalization.
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