A Multipronged Intervention to Improve Outpatient Care Following Hospitalization With Acute Kidney Injury: An Implementation Study Protocol.

Background: Acute kidney injury (AKI)-related hospitalizations are associated with long-term health consequences, but post-AKI management and monitoring in the outpatient primary care setting are suboptimal. Documentation and communication about in-hospital AKI episodes to patients' primary care providers are often inadequate. Awareness of AKI among patients is generally poor. Objective: To develop a multifaceted intervention package to improve post-AKI care, to evaluate its implementation using feasibility and process metrics, and to observe its short-term effectiveness. Design: Mixed-methods feasibility study with type 3 hybrid implementation/effectiveness design. Participants: Kidney specialist physicians on inpatient consultation service at three hospital sites in British Columbia (in New Westminster, Prince George, Vancouver) will deliver the intervention package to patients with AKI and their primary care providers. Measurements: Implementation outcomes include reach, adoption, fidelity, and sustainment of the intervention. Implementation determinants, including acceptability, adaptability, feasibility, appropriateness, and satisfaction, will be assessed with surveys and focus groups with kidney specialist physicians, primary care providers, and patients/caregivers. Short-term effectiveness outcomes include: patient follow-up visits with primary care providers, and kidney lab testing at three months; AKI awareness and self-efficacy among primary care providers and patients. Methods: Guided by the Theoretical Domains Framework, we conducted focus groups with interest holders to identify the barriers, challenges, and needs in post-AKI care and then applied this information to develop an intervention package, including an AKI-specific discharge/sign-off template, a post-AKI medication management guide, educational websites for providers and patients, and a patient handout. In this six-month implementation feasibility study, the implementation strategies will be initiated sequentially at each site for four to eight weeks. Quantitative data will be collected via self-report, chart review, surveys, and website hits and analyzed using descriptive statistics. Postimplementation qualitative data will be collected from focus groups/interviews and will be analyzed by identifying codes and categorizing them into themes. Limitations: The study will take place in the setting of nephrology consultation services. Adaptations to implementation strategies would be required for delivery of the intervention by other inpatient providers. Conclusions: The study will evaluate feasibility and preliminary effectiveness of a multifaceted intervention aimed at improving care coordination between specialists and primary care providers and care transition following hospital discharge in patients experiencing AKI. Study Registration: This study is not registered.