Patient Safety and Acute Kidney Injury

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DESCRIPTION (provided by the applicant): Dr. Brown received his MS and PhD from Dartmouth College in health services research and quality improvement, under the mentorship of Dr. Paul Batalden (masters) and Dr. Gerald T. O'Connor (doctorate). He is currently a successful instructor at The Dartmouth Institute for Health Policy and Clinical Practice with a commitment to be advanced to a tenure-track assistant professor at Dartmouth working on patient safety issues in cardiovascular interventions. MENTORS: Dr. Gerald T. O'Connor, PhD, ScD, is a renowned epidemiologist and health services researcher in cardiovascular disease and patient safety with a long track record of successfully mentoring career development awardees with AHRQ K-08, AHRQ K-02, NCI K-05 support. Dr. Mark J. Sarnak, MD, MS is an expert nephrologist and researcher in chronic kidney disease and aging with a history of NIH funding and mentoring. Along with a team of leading researchers serving as Dr. Brown's advisory committee, Drs. O'Connor and Sarnak will ensure the success of Dr. Brown's research training, project, and overall career development. RESEARCH: Patient safety in percutaneous coronary interventions (PCI) is a problem that affects over 1.2 million patients each year in the United States. Contrast-induced acute kidney injury (CI-AKI) is recognized as an important patient safety objective for the National Quality Forum. CI-AKI is a complication leading to chronic kidney disease (CKD), end-stage renal disease (ESRD), and death following PCI. A major problem is the lack of adoption of prophylactic strategies, safe dosing of contrast for patients at risk of CI-AKI, and transition of care between cardiology and nephrology. The aims of the proposal are: 1) to evaluate whether high-intensity quality improvement reduces the risk of CI-AKI; and 2) to evaluate whether CI-AKI is associated with the development of CKD, progression of CKD, development of ESRD, repeat-revascularization, and long-term mortality. For specific aims 1 and 2 we will prospectively implement high-intensity quality improvement at 8 centers in the Northern New England Cardiovascular Disease Study Group (N=32,000), collect in-hospital outcomes, long-term mortality, ESRD, repeat revascularizations, and qualitative data on success and barriers to improvement from teams at each center. For Aim 2 we will also investigate the problem of CI-AKI using administrative data from the Veterans Health Administration by utilizing the patient treatment files and laboratory files from 2003-2007 to identify a PCI cohort (N=30,000) and subsequent renal complications and death. Both aims are focused on providing high quality, patient-centered care. At the completion of this career development award, Dr. Brown will have the skills and experience in health services research, patient safety, and quality improvement that will enable him to succeed as a dynamic independent investigator. PUBLIC HEALTH RELEVANCE: Over two million cardiac procedures are performed each year in the United States; these procedures use contrast dye for imaging purposes, which directly injures or severely impairs the patient's kidneys. As a result, over 200,000 patients each year develop kidney injury from the contrast dye, resulting in dialysis and death. We will work with clinicians from different disciplines to improve patient safety, protect against kidney injury, and identifying early risk factors that may be modified to reduce the risk of organ injury.