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

Authors

  • J. Bissonnette,

    Corresponding author
    1. Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
    • Division of Nephrology, Renal Transplant Program, The Ottawa Hospital, Ottawa, ON, Canada
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  • K. Woodend,

    1. Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
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  • B. Davies,

    1. Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
    2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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  • D. Stacey,

    1. Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
    2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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  • G. A. Knoll

    1. Division of Nephrology, Renal Transplant Program, The Ottawa Hospital, Ottawa, ON, Canada
    2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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  • Conflict of interest: The authors of this manuscript have no conflicts of interest to disclose as described by the Clinical Transplantation.

Corresponding author: Dr. J. Bissonnette, The Ottawa Hospital, Riverside Campus, 1967 Riverside Drive, Ottawa, ON, Canada K1H 7W9.

Tel.: +1 613 738 8400 ext. 81872; fax: +1 613 738 8489; e-mail: jabissonnette@ottawahospital.on.ca

Abstract

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.

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