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Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal
Alicia M Neu1, Troy Richardson2, John Lawlor2
1Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
The Standardizing Care to improve Outcomes in Pediatric End stage renal disease (SCOPE) Collaborative significantly reduced peritonitis rates in pediatric chronic peritoneal dialysis patients. Increased adherence to standardized care practices led to a 42% decrease in peritonitis rates.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Public Health
Background:
- Peritonitis is a major complication in pediatric chronic peritoneal dialysis.
- Standardized care practices are crucial for improving outcomes in pediatric end-stage renal disease.
- The Standardizing Care to improve Outcomes in Pediatric End stage renal disease (SCOPE) Collaborative was established to address these issues.
Purpose of the Study:
- To evaluate the impact of the SCOPE Collaborative on peritonitis rates in pediatric chronic peritoneal dialysis patients.
- To assess the implementation of standardized care practices within the SCOPE Collaborative.
- To determine the relationship between care bundle compliance and peritonitis rates.
Main Methods:
- Analysis of monthly care bundle compliance and annualized peritonitis rates from 24 SCOPE centers.
- Inclusion of 644 patients and 7977 follow-up encounters over 36 months.
- Statistical modeling including logistic regression and generalized linear mixed models to assess changes in compliance and peritonitis rates.
Main Results:
- Likelihood of compliance with follow-up care practices increased significantly (OR 1.15).
- Mean monthly peritonitis rates decreased significantly from 0.63 episodes/patient year prelaunch to 0.42 postlaunch.
- A sensitivity analysis showed peritonitis rates decreased as compliance increased, reaching statistical significance at 80% compliance.
Conclusions:
- The SCOPE Collaborative successfully increased the implementation of standardized follow-up care in pediatric peritoneal dialysis.
- A significant reduction in average monthly peritonitis rates was achieved within the first 3 years of the collaborative.
- Increased adherence to standardized care is directly associated with decreased peritonitis rates in this population.
Abstract:
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.
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