Measuring Quality in Lung Transplant Care: The QUILT Initiative

Abstract

<h3>Purpose</h3> Lung transplant aims to improve quality of life and survival. Achieving this requires providing care that prevents chronic lung allograft dysfunction (CLAD) while minimizing complications of long-term immunosuppression. We developed the quality in lung transplant (QUILT) initiative as a comprehensive and sustainable process to measure quality of care and develop interventions to improve it in our center. <h3>Methods</h3> In October 2019, we selected complications of lung transplant associated with increased risk of end-organ damage or death that could be tracked continuously leveraging the electronic medical record. The selected metrics were CLAD, acute kidney injury (AKI) and chronic kidney disease (CKD) based on KDIGO stages, leukopenia, and hyperglycemia. We developed an information pipeline in which daily laboratory results are aggregated and analyzed at regular intervals. We assessed the QUILT metrics during 2020 and their trajectory since 2011. Finally, we incorporated them to our quarterly morbidity and mortality review. We focused on AKI and CKD for this abstract. <h3>Results</h3> In 2020, 469 lung recipients received transplant care at UCSF. The composition of the cohort based on years after transplant was 0-1 years (19%), >1-3 years (22%), >3-5 years (19%), >5-10 years (27%), >10-15 years (9%), and >15 years (3%). The monthly incidence of AKI ranged from 18-25%, including stage 1 (15-21%), stage 2 (1-4%), and stage 3 (1-2%). Since 2011, the monthly incidence of AKI has decreased from a peak of 31%. The prevalence of CKD ranged from 20-25% stage 1, 22-23% stage 2, 38-45% stage 3, 8-10% stage 4, and 4-5% stage 5. Since 2011, the prevalence of CKD has been stable for stages 1 and 2, has increased for stages 3 and 5, and has decreased for stage 4. <h3>Conclusion</h3> QUILT allows longitudinal and real-time assessment of quality of care metrics. Tracking AKI and CKD increased our vigilance of medication management. This framework could help centers develop systematic and patient-specific improvement interventions, and track the trajectory of care over time.