Overview
The purpose of this study is to determine the effect of a multidisciplinary intervention at care transitions for acute kidney injury survivors on patient-centered outcomes.
Eligibility
Inclusion Criteria:
- Clinician subjects
- Hospital clinicians including physicians and advanced practice providers employed by Mayo Clinic and practicing at one of the four study sites
- Provide care for hospitalized patients with stage 2 or stage 3 acute kidney injury (AKI) who are expected to be discharged home and are not receiving dialysis
- Patient subjects:
- Adults ≥18 years old
- Meet KDIGO consensus criteria for stage 2 (moderate) or 3 (severe) AKI
- Residence within the study catchment area (southern Minnesota, northern Iowa, or western Wisconsin)
Exclusion Criteria:
- Clinician subjects: Physicians and advanced practice providers who:
- Care exclusively for pediatric patients (\<18 years)
- Care exclusively for patients on palliative care
- Patient subjects
- Discharged to hospice care
- Require outpatient dialysis at discharge
- Are admitted from or expected to be discharged to a skilled nursing facility
- Dementia Diagnosis
- Have undergone solid organ transplant within the past 100 days
- Decline authorization for use of their medical records for research
