Reliable individualized monitoring improves cholesterol control in kidney transplant recipients (NLM)
Abstract
Objective: To develop and evaluate a system for reliable and efficient individualized risk-based monitoring of cholesterol and 11 other tests after kidney transplantation in children.
Methods: We identified system components that drive reliable individualized monitoring and used quality improvement methods to develop and implement interventions, including (1) monitoring schedules individualized by dyslipidemia risk assigned to each patient, (2) automated previsit decision support from our electronic medical record, (3) standardized work flow and responsibility, and (4) automated forwarding of results to providers. We measured the proportion of patients due for cholesterol testing who had it performed within 1 week of their clinic visit and the proportion of patients in our population who achieved low-density lipoprotein (LDL) cholesterol control at baseline and for 2 years after improved monitoring.
Results: The proportion of visits in which cholesterol monitoring was completed when indicated improved from 80% to 98% within 8 months and was sustained for more than 1 year. The number of patients with controlled LDL (<130 mg/dL, 3.3 mmol/L) improved from 44 (71%) of 62 at the start of our project to 58 (94%) of 62 (P = .002) at an average follow-up of 24 months.
Conclusions: Using quality improvement and health information technology, we achieved sustained, reliable and efficient personalized monitoring of cholesterol and 11 other tests. This approach enabled substantial improvement in LDL cholesterol control. Structured methods of system redesign that leverage information technology systems hold promise for rapidly achieving reliable individualized care in other settings.
Cited by 7 articles
Translation of evidence into kidney transplant clinical practice: managing drug-lab interactions by a context-aware clinical decision support system.Niazkhani Z, Fereidoni M, Rashidi Khazaee P, Shiva A, Makhdoomi K, Georgiou A, Pirnejad H.BMC Med Inform Decis Mak. 2020 Aug 20;20(1):196. doi: 10.1186/s12911-020-01196-w.PMID: 32819359 Free PMC article.
Effect and features of information technology-based interventions on self-management in adolescent and young adult kidney transplant recipients: a systematic review.Ganjali R, Khoshrounejad F, Mazaheri Habibi MR, Taherzadeh Z, Golmakani R, Mostafavi SM, Eslami S.Adolesc Health Med Ther. 2019 Oct 15;10:173-190. doi: 10.2147/AHMT.S200801. eCollection 2019.PMID: 31686939 Free PMC article.
Long-Term Outcomes of Kidney Transplantation in Children.Winterberg PD, Garro R.Pediatr Clin North Am. 2019 Feb;66(1):269-280. doi: 10.1016/j.pcl.2018.09.008.PMID: 30454748 Free PMC article. Review.
Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review.Kruse CS, Beane A.J Med Internet Res. 2018 Feb 5;20(2):e41. doi: 10.2196/jmir.8793.PMID: 29402759 Free PMC article.
Assessing barriers to adherence in routine clinical care for pediatric kidney transplant patients.Varnell CD Jr, Rich KL, Nichols M, Dahale D, Goebel JW, Pai ALH, Hooper DK, Modi AC.Pediatr Transplant. 2017 Nov;21(7):10.1111/petr.13027. doi: 10.1111/petr.13027. Epub 2017 Aug 1.PMID: 28762577 Free PMC article.
Show more "Cited by" articles