Medication Intervention in Transitional Care to Optimize Outcomes & Costs for CKD & ESRD (CKD/ESRD-MIT)

Study Description

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

Transitional care strategies focused on enhancing the accuracy and comprehensiveness of medication information transfer will lead to improved health outcomes among hospitalized patients with chronic kidney disease.

Condition or disease	Intervention/treatment	Phase
Chronic Kidney Disease; End-Stage Renal Disease	Other: Medication Information Transfer Intervention; Other: Usual care for hospital discharge	Not Applicable

Detailed Description:

Patients with CKD and ESRD have more co-morbidities, are hospitalized more often and for longer lengths of stay, and incur greater healthcare costs than patients with other chronic conditions. Enhanced hospital to home transitional care interventions have been shown to improve medication information transfer, reduce hospital readmissions, and slow the progression of declining health in the general population of hospitalized patients. What is not known is the impact enhanced transitional care can have for a very high-risk population, such as those with CKD and ESRD. Interventions that prevent or slow CKD progression, i.e. blood pressure control and intensive glycemic control in patients with diabetes, are all highly dependent on meticulous medication management.

For hospitalized patients with CKD or ESRD who are transitioning to home, accurate and comprehensive information transfer is essential to optimal medication management. CKD and ESRD patients are in critical need of improved transitional care that includes accurate and comprehensive medication information transfer. The main objective of this application is to pilot-test the effectiveness of a medication information transfer intervention to improve clinically-relevant outcomes. To this end, the following Specific Aims will be achieved: 1. Evaluate the impact of transitional care interventions on acute care utilization following hospital discharge among patients with CKD or ESRD. 2. Evaluate the impact of transitional care strategies on management of CKD or ESRD management and complications.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	120 participants
Allocation:	Randomized
Intervention Model:	Parallel Assignment
Masking:	Single (Outcomes Assessor)
Primary Purpose:	Health Services Research
Official Title:	Medication Intervention in Transitional Care to Optimize Outcomes & Costs in CKD & ESRD
Study Start Date :	November 2011
Actual Primary Completion Date :	December 2015
Actual Study Completion Date :	April 2016

Arms and Interventions

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Arm	Intervention/treatment
Active Comparator: control; usual care for hospital discharge: CKD group; ESRD group	Other: Usual care for hospital discharge; Patients will receive medication information according to standard practice for discharge of hospitalized patients.
Active Comparator: intervention; pharmacist administered medication information transfer intervention; CKD group; ESRD group	Other: Medication Information Transfer Intervention; A pharmacist will visit participants randomized to the intervention group in their homes within 5 days of hospital discharge to administer the 5As Medication Self-Management intervention: Assessment, Advise, Agreement, Assistance, Arrangements.

Outcome Measures

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Primary Outcome Measures :

1. acute care utilization [ Time Frame: 90 days ]
   Acute care utilization defined by emergency department visits and hospitalizations in the first 30 and 90 days after discharge from the index hospitalization.

Secondary Outcome Measures :

1. CKD status, risk factors and complications [ Time Frame: 30 and 90 days ]
   blood pressure, eGFR, urine albumin/creatinine ratio, fasting glucose, HbA1c (in the diabetic subgroup), lipids, hemoglobin, phosphorus, PTH, serum potassium.
2. ESRD status, risk factors and complications: [ Time Frame: 30 and 90 days ]
   blood pressure, fasting glucose,HbA1c (in the diabetic subgroup), lipids, hemoglobin, phosphorus, PTH, serum potassium

Eligibility Criteria

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	21 Years and older (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria for CKD arm:

1. Hospitalized patients
2. > 21 years of age
3. Diagnosis of CKD stages 3-5, not treated by dialysis

Inclusion Criteria for ESRD arm:

1. Hospitalized patients
2. > 21 years of age
3. Patients treated with hemodialysis or peritoneal dialysis

Exclusion Criteria:

1. Kidney Transplant

Contacts and Locations

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Locations

United States, Washington
Providence Sacred Heart Medical Center & Children's Hospital
Spokane, Washington, United States, 99204

Sponsors and Collaborators

Providence Medical Research Center

Washington State University

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Health Sciences & Services Authority of Spokane County

Providence Sacred Heart Medical Center & Children's Hospital

Investigators

Principal Investigator:	Katherine R Tuttle, MD	Providence Sacred Heart Medical Center and Children's Hospital; University of Washington School of Medicine
Principal Investigator:	Cynthia L Corbett, PhD	Washington State University College of Nursing

More Information

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	Providence Medical Research Center
ClinicalTrials.gov Identifier:	NCT01459770 History of Changes
Other Study ID Numbers:	1R34DK094016-01 ( U.S. NIH Grant/Contract ); R34DK094016-01 ( U.S. NIH Grant/Contract ); RFP # 7 ( Other Grant/Funding Number: Washington State Health Sciences & Services Authority )
First Posted:	October 26, 2011
Last Update Posted:	April 6, 2017
Last Verified:	April 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD:	No

Keywords provided by Providence Medical Research Center:

glomerular filtration rate; albuminuria; medical therapy; hospital discharge	hospital readmission; CKD complications; CKD risk factors

Additional relevant MeSH terms:

Kidney Diseases; Renal Insufficiency, Chronic; Kidney Failure, Chronic; Urologic Diseases; Renal Insufficiency