{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T21:55:38Z","timestamp":1793310938536,"version":"4.5.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,5,20]]},"abstract":"<jats:sec id=\"jah310879-sec-0001\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">In the IMPROVE AKI (A Cluster\u2010Randomized Trial of Team\u2010Based Coaching Interventions to Improve Acute Kidney Injury) trial, a combination of team\u2010based coaching and data\u2010driven surveillance dashboards reduced the odds of AKI following cardiac catheterization by 46%. The objective of this study was to determine if improvements in AKI outcomes would be sustained after completion of the active intervention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah310879-sec-0002\" xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">A 2\u00d72 factorial cluster\u2010randomized trial with an 18\u2010month active intervention phase (October 2019\u2013March 2021) and an 18\u2010month sustainability phase (April 2021\u2013September 2022) conducted among cardiac catheterization laboratories in 20 Veterans Affairs sites. Interventions included team\u2010based coaching in a virtual learning collaborative or technical assistance, with and without access to an automated surveillance reporting dashboard. Data were collected on procedures involving adult patients undergoing diagnostic coronary angiography or percutaneous coronary interventions and not receiving chronic dialysis. The main outcome was AKI within 7\u2009days of cardiac catheterization among all participants and those with preexisting chronic kidney disease. In addition, survey and focused interview data were collected to understand barriers and facilitators to sustaining AKI improvements. In this phase, 440 of 4160 patients experienced AKI, including 216 of 1260 patients with chronic kidney disease. Compared with technical assistance alone, we observed a reduction in AKI among virtual learning collaborative + automated surveillance reporting sites (adjusted odds ratio, 0.60 [95% CI, 0.42\u20130.86]). Sites had implemented standardized orders (11), oral and intravenous hydration standing orders (13), and contrast limiting protocols (10).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah310879-sec-0004\" xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Team\u2010based coaching coupled with data\u2010driven surveillance dashboards reduced AKI by 40% during the 18 months after active participation in the trial. Process improvement education, care process standardization, and automated outcome feedback may be effective and durable methods for reducing AKI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah310879-sec-0005\" xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/\">https:\/\/clinicaltrials.gov\/<\/jats:ext-link>\n              ; Unique Identifier: NCT03556293.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.038920","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T09:37:52Z","timestamp":1747301872000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Sustained Improvements After Intervention to Prevent Contrast\u2010Associated Acute Kidney Injury: A Randomized Controlled Trial"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3217-4147","authenticated-orcid":false,"given":"Michael E.","family":"Matheny","sequence":"first","affiliation":[{"name":"Vanderbilt University Medical Center","place":["Nashville, USA"]},{"name":"Tennessee Valley Healthcare System VA","place":["Nashville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Carpenter\u2010Song","sequence":"additional","affiliation":[{"name":"Dartmouth College","place":["Hanover, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iben M.","family":"Ricket","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth","place":["Hanover, USA"]},{"name":"The Dartmouth Institute for Health Policy and Clinical Practice","place":["Lebanon, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Solomon","sequence":"additional","affiliation":[{"name":"University of Vermont Larner College of Medicine","place":["Burlington, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meagan E.","family":"Stabler","sequence":"additional","affiliation":[{"name":"Dartmouth\u2010Hitchcock Medical Center","place":["Lebanon, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0792-8867","authenticated-orcid":false,"given":"Sharon E.","family":"Davis","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center","place":["Nashville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0728-2237","authenticated-orcid":false,"given":"Lisa","family":"Zubkoff","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham and VA Birmingham Health Care","place":["Birmingham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9547-7789","authenticated-orcid":false,"given":"Dax M.","family":"Westerman","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center","place":["Nashville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4886-6159","authenticated-orcid":false,"given":"Chad","family":"Dorn","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center","place":["Nashville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Cox","sequence":"additional","affiliation":[{"name":"Dartmouth College","place":["Hanover, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4513-2704","authenticated-orcid":false,"given":"Freneka F.","family":"Minter","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center","place":["Nashville, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8754-358X","authenticated-orcid":false,"given":"Hani","family":"Jneid","sequence":"additional","affiliation":[{"name":"University of Texas Medical Branch","place":["Galveston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse W.","family":"Currier","sequence":"additional","affiliation":[{"name":"Veteran Affairs Greater Los Angeles Healthcare System","place":["Los Angeles, USA"]},{"name":"University of California Los Angeles Healthcare System","place":["Los Angeles, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8993-1367","authenticated-orcid":false,"given":"S. Ahmed","family":"Athar","sequence":"additional","affiliation":[{"name":"Loma Linda VA Medical Center","place":["Loma Linda, USA"]},{"name":"Loma Linda University School of Medicine","place":["Loma Linda, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4784-4513","authenticated-orcid":false,"given":"Saket","family":"Girotra","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center","place":["Dallas, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8905-4448","authenticated-orcid":false,"given":"Calvin","family":"Leung","sequence":"additional","affiliation":[{"name":"Orlando VA Medical Center","place":["Orlando, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5651-4401","authenticated-orcid":false,"given":"Thomas J.","family":"Helton","sequence":"additional","affiliation":[{"name":"East Tennessee State University","place":["Johnson City, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Wright State University Dayton VA Medical Center","place":["Dayton, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mladen I.","family":"Vidovich","sequence":"additional","affiliation":[{"name":"University of Illinois at Chicago","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8616-4916","authenticated-orcid":false,"given":"Mary E.","family":"Plomondon","sequence":"additional","affiliation":[{"name":"VHA Office of Quality and Safety","place":["Washington, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0678-4873","authenticated-orcid":false,"given":"Stephen W.","family":"Waldo","sequence":"additional","affiliation":[{"name":"VHA Office of Quality and Safety","place":["Washington, USA"]},{"name":"Rocky Mountain Regional VA Medical Center","place":["Aurora, USA"]},{"name":"University of Colorado School of Medicine","place":["Aurora, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly A.","family":"Aschbrenner","sequence":"additional","affiliation":[{"name":"Dartmouth College","place":["Hanover, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9299-3294","authenticated-orcid":false,"given":"Virginia","family":"McKay","sequence":"additional","affiliation":[{"name":"University in St. Louis, MO (V.M.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8389-6217","authenticated-orcid":false,"given":"A. 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