Acute kidney injury (AKI) affects up to 20% of hospitalized Veterans and is strongly associated with morbidity and death. AKI is a diverse condition and timely and accurate diagnosis of the type of AKI is critical to begin appropriate therapies, especially those causes that require specific treatments beyond general supportive care. Yet, there are still significant gaps in the initial evaluation of AKI among hospitalized patients. Clinical decision support systems (CDSS) have shown promise to address these barriers, but most consist of simple alerting schemes and general care recommendations provided at a single point in time. The goal of this proposal is to develop and test the feasibility and usability of a rule-based and Artificial Intelligence-assisted precision CDSS tool (PRECISE-AKI) that can provide cognitive support to improve timely initial diagnostic evaluation of AKI.
Eligible providers will be those that have at least 4 weeks of inpatient ward team or consultation team activity during a 12-month period.
Case inclusion criteria will consist of hospitalizations that meet criteria for Kidney Disease Improving Global Outcomes Stage 2 injury or persistent Stage 1 injury seen by eligible providers.
Ineligible providers will be those that have < 4 weeks of inpatient ward team of consultative team activity during a 12 month period.
Hospitalizations with non-persistent (<48 hours) stage 1 injury or less.
Crossover
PRECISE-AKI Clinical Decision Support Tool
Other interventionThe Intervention arm will consist of Clinical Decision Diagnostic Support (CDS) provided by the PRECISE-AKI tool
Rates of Appropriate Diagnostic Testing
Based on the presenting context, the investigators will compare rates of appropriate diagnostic testing between intervention and control patients among those meeting the AKI case definition
Exploratory Clinical Outcome: Peak Kidney Disease Improving Global Outcomes (KDIGO) AKI Stage during hospitalization.
For this exploratory clinical outcome, we will compare differences in the peak KDIGO AKI Stage (creatinine-based criteria) during hospitalization after meeting the case definition of AKI between intervention and control cases.
Exploratory Clinical Outcome: Discharge serum creatinine
The investigators will compare differences in the hospital discharge serum creatinine after meeting the case definition of AKI between intervention and control cases.
Exploratory Clinical Outcome: Major Adverse Kidney Events (MAKE) 90
For this exploratory clinical outcome, the investigators will compare the rates of the major adverse kidney events experienced by eligible AKI cases in the intervention compared with the control arm. Major Adverse Kidney Events will be defined as kidney replacement therapy, death, or an increase in baseline serum creatinine of 150% of baseline using the last serum creatinine available up to 90 days.
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VA Office of Research and Development
Lead sponsor
VA Tennessee Valley Health Care System
Collaborator
Vanderbilt University Medical Center
Collaborator
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