Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis

• DOI: 10.1016/j.kint.2016.02.015
• Publication Date: 2016-04-14T00:37:12Z
• Authors: Alicia M. Neu; Troy Richardson; John Lawlor; Jayne Stuart; Jason Newland; Nancy McAfee; Bradley A. Warady; Joshua Zaristky; Susan Kieffner; Allison Redpath M...; Dawn Foster; Mahima Keswani; Nancy Majkowski; Richard Blaszak; Christine Blaszak; Michael Somers; Theresa Pak; Diego Aviles; Evie Jenkins; Rachel Lestz; Alice Sanchez; Cynthia Pan; Jackie Dake; Raymond Quigley; Bradley Warady; JoLyn Grimes; Kirtida Mistry; Jennifer Carver; Rene Van De Voorde; Ellen Irvin; Samhar Al-Akash; Britt Stone; Guillermo Hidalgo; Malinda Harrington; Alicia Neu; Barbara Case; Sushil Gupta; Andrea Baker; Jack Weaver; Annabelle Chua; Cynthia Wong; Brandy Begin; Isidro Salusky; Barbara Gales; Hiren Patel; Beth Smith; Mark Joseph; Deb Haskins; David Kenagy; Beth Vogt; Coral Hanevold; Nancy McAfee; Ann Beck; Meg Shea; Christine Sethna; Myung Cho; Sarah Scwartz; Helen Currier; Amy Skversky; Maureen Eisele; Madhura Pradhan; Christine Breen; Paul Brakeman; Lina Campopiano; Jennifer Jetton; Jennifer Ehrlich; Lawrence Shoemaker; Nancy Zacharek
• Keywords: Male; Adolescent; Infant, Newborn; Aftercare; Infant; Guidelines as Topic; Peritonitis; Quality Improvement; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Child, Preschool; Odds Ratio; Humans; Kidney Failure, Chronic; Patient Compliance; Female; Guideline Adherence; Child; Peritoneal Dialysis; Patient Care Bundles; Follow-Up Studies

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.