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

Sep 30, 2026

Uploaded by Finn

Acute kidney injury survivors face high risk of inadequate follow-up after hospital discharge, so this mixed methods feasibility study tested a multidisciplinary transitional care model called Acute Kidney Injury in Care Transitions (ACT). The embedded convergent design ran within a randomized trial at a single academic medical center and included stage 3 AKI patients discharged home (not on dialysis) and staff delivering ACT components. Survey completion and qualitative interviews showed broad feasibility and acceptability, with most staff endorsing the program and nearly all patients recommending it. Results supported flexible, minimally disruptive workflow integration, while timely discharge coordination remained a priority.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Rationale & Objective

Study Design

Setting & Participants

Analytical Approach

Results

Limitations

Conclusions

Original Research Implementing the Acute Kidney Injury in Care Transitions (ACT) Program: Results From a Mixed Methods Feasibility Study Heather P. May, Caroline B. Ledet, Joan M. Griffin, Joseph R. Herges, Kianoush B. Kashani, Andrea G. Kattah, Rozalina G. McCoy, Angeliki G. Tinaglia, Andrew D. Rule, and Erin F. Barreto, for the ACT Study Rationale & Objective: 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) . Study Design: Embedded convergent mixed methods study within a randomized trial. Setting & Participants: The trial was conducted ata 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. Analytical Approach: Descriptive analysis of surveys and themes from qualitative interviews was integrated using embedding. Results: 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. Limitations: Data was collected from willing trial participants within a well-resourced health care system. Health systems’ specific needs should be evaluated when generalizing results. Conclusions: 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 healthcare team to minimize sole reliance on specialist resources. This mixed methods data indicates feasibility and broad acceptability and engagement with the approach. Complete author and article information provided before references. Correspondence to H.P. May (may.heather@ [mayo.edu](mayo.edu)) Kidney Med. 8(1):101178. Published online November 6, 2025. doi: 10.1016/j. xkme.2025.101178 © 2025 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BYNC-ND license ([http://](http://)[ ](http://)[creativecommons.org/](creativecommons.org/)[ ](creativecommons.org/)[licenses/by-nc-nd/4.0/](licenses/by-nc-nd/4.0/)). Acute kidney injury (AKI) is a common complication in hospitalized patients, affecting at least 1 in 4.1 , 2 The 80%-90% of patients that survive AKI experience an increased risk of chronic kidney disease, hospital readmissions, recurrent AKI, cardiovascular events, and reduced quality of life.3-7 Following discharge, inadequate kidney health monitoring, exposure to nephrotoxic medications, and failure to resume nephroprotective drugs are associated with worse kidney outcomes.8-12 Despite these threats to future health, post-AKI kidney health evaluation rates among survivors are poor. Thirty percent fail to receive a serum creatinine measurement and clinic visit within 30 days of hospital discharge. 13 Postdischarge evaluations by nephrologists occur in only 8%-43% of patients.14 , 15 Care models that facilitate inpatientto-outpatient transitional care, such as nephrologist-led postAKI car

FAQs

What problem does the ACT program address after acute kidney injury?

AKI survivors are at risk of not receiving needed follow-up care after discharge. ACT aims to improve transitional kidney health evaluation and coordination from hospital to home.

How was the ACT program evaluated in this study?

The study used an embedded convergent mixed methods design within a randomized trial, combining survey data with qualitative interviews of patients and healthcare staff.

What did the results show about feasibility and acceptability?

More than 80% of healthcare staff agreed ACT was feasible and acceptable, and 95% of patients would recommend ACT to others. The multidisciplinary approach and integration into existing workflows were received enthusiastically.

Sep 30, 2026

Uploaded by Finn