Implementing the Acute Kidney Injury in Care Transitions (ACT) Program: Results From a Mixed Methods Feasibility...

Acute kidney injury (AKI) survivors are at risk for not receiving necessary follow-up medical care after discharge. This study assessed feasibility and acceptability of a multidisciplinary AKI survivor care delivery model (AKI in care transitions, ACT).

Embedded convergent mixed methods study within a randomized trial.

The trial was conducted at a single academic medical center. Included individuals had stage 3 AKI during a hospitalization and were discharged to home and not on dialysis or were health care staff delivering ACT's components.

Descriptive analysis of surveys and themes from qualitative interviews was integrated using embedding.

Surveys were completed by 19 patients and 10 health care staff. Ten patients and 13 health care staff were interviewed. More than 80% of health care staff agreed ACT was feasible and acceptable, and 95% of patients would recommend ACT to others. The multidisciplinary approach, including pharmacists and nurses, and numerous kidney health touchpoints throughout care transitions were met with enthusiasm. Smooth integration of workflows and care elements with existing practices promoted acceptability. Developing efficient workflows to facilitate timely hospital discharge remains a priority. The diffuse and heterogenous nature of AKI and deprioritization of kidney health, relative to other disease states, represent challenges for ACT and similar programs.

Data was collected from willing trial participants within a well-resourced health care system. Health systems' specific needs should be evaluated when generalizing results.

The unique needs of patients and health care contexts call for flexible solutions to bridge the post-AKI care gap. The ACT intervention was designed with a small footprint to address previously identified patient priorities, leverage principles of minimally disruptive medicine, and engage the multidisciplinary health care team to minimize sole reliance on specialist resources. This mixed methods data indicates feasibility and broad acceptability and engagement with the approach.