Care That Fits: Optimizing Value-Based Care for Acute Kidney Injury Survivors

Acute kidney injury (AKI) survivors are at risk for substantial adverse outcomes, and the post-AKI setting is a source of high health care utilization. Kidney health is often not prioritized after discharge from an AKI hospitalization and can be complicated by patient and process-related barriers. Improving kidney care for AKI survivors has the potential to improve outcomes, though data on which care models are optimal for this population are lacking. Care models utilized in other patient populations, as well as prior trials of AKI survivor clinics, can provide insight as to how these models could be implemented in the post-AKI setting to improve outcomes in a cost-effective way. Potential care models range on a spectrum from the least specialized, most highly scalable, and cost-effective options, such as patient engagement programs and home health, to more generally accessible models including allied health-driven models, and primary care-embedded programs, to highly specialized and less scalable options, such as nephrology-led survivor clinics. Each has potential applications and limitations in the post-AKI setting. Ongoing studies that incorporate elements of multiple care models may have the most promise to improve value-based care in the care of AKI survivors.