The improving renal outcomes collaborative: Blood pressure measurement in transplant recipients

Michael E. Seifert, Devesh S. Dahale, Margret Kamel, Pamela D. Winterberg, Gina Marie Barletta, Craig W. Belsha, Abanti Chaudhuri, Joseph T. Flynn, Rouba Garro, Roshan P. George, Jens W. Goebel, David B. Kershaw, Debora Matossian, Jason Misurac, Corina Nailescu, Christina R. Nguyen, Meghan Pearl, Ari Pollack, Cozumel S. Pruette, Pamela SingerJudith S. VanSickle, Priya Verghese, Bradley A. Warady, Andrew Warmin, Patricia L. Weng, Larysa Wickman, Amy C. Wilson, David K. Hooper

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND OBJECTIVES: Hypertension is highly prevalent in pediatric kidney transplant recipients and contributes to cardiovascular death and graft loss. Improper blood pressure (BP) measurement limits the ability to control hypertension in this population. Here, we report multicenter efforts from the Improving Renal Outcomes Collaborative (IROC) to standardize and improve appropriate BP measurement in transplant patients. METHODS: Seventeen centers participated in structured quality improvement activities facilitated by IROC, including formal training in quality improvement methods. The primary outcome measure was the proportion of transplant clinic visits with appropriate BP measurement according to published guidelines. Prospective data were analyzed over a 12-week preintervention period and a 20-week active intervention period for each center and then aggregated as of the program-specific start date. We used control charts to quantify improvements across IROC centers. We applied thematic analysis to identify patterns and common themes of successful interventions. RESULTS: We analyzed data from 5392 clinic visits. At baseline, BP was measured and documented appropriately at 11% of visits. Center-specific interventions for improving BP measurement included educating clinic staff, assigning specific team member roles, and creating BP tracking tools and alerts. Appropriate BP measurement improved throughout the 20-week active intervention period to 78% of visits. CONCLUSIONS: We standardized appropriate BP measurement across 17 pediatric transplant centers using the infrastructure of the IROC learning health system and substantially improved the rate of appropriate measurement over 20 weeks. Accurate BP assessment will allow further interventions to reduce complications of hypertension in pediatric kidney transplant recipients.

Original languageEnglish (US)
Article numbere20192833
JournalPediatrics
Volume146
Issue number1
DOIs
StatePublished - Jul 2020
Externally publishedYes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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  • Cite this

    Seifert, M. E., Dahale, D. S., Kamel, M., Winterberg, P. D., Barletta, G. M., Belsha, C. W., Chaudhuri, A., Flynn, J. T., Garro, R., George, R. P., Goebel, J. W., Kershaw, D. B., Matossian, D., Misurac, J., Nailescu, C., Nguyen, C. R., Pearl, M., Pollack, A., Pruette, C. S., ... Hooper, D. K. (2020). The improving renal outcomes collaborative: Blood pressure measurement in transplant recipients. Pediatrics, 146(1), [e20192833]. https://doi.org/10.1542/peds.2019-2833