This document summarizes a study on whether clinical pathways are effective for patients with acute kidney injury (AKI) compared to usual care. The study, called CHAMP-Path, was a pragmatic randomized controlled trial. It found that while median length of hospital stay was slightly lower for the pathway care group compared to usual care, the difference was not statistically significant based on intention-to-treat and per protocol analyses. Secondary outcomes like in-hospital mortality and 30-day readmissions were also not significantly different between the two groups. The conclusions were that pathway care may be clinically effective but the study was not definitive, and further ongoing trials are still needed.

1. Are Pathways Effective in
Acute Kidney Injury (AKI)?
A CHAMP-Path Pragmatic RCT
September 10, 2014
KSAU-HS Convention Center, Jeddah
Dr. Akram Ahmad | Medical Resident, R3
Department of Internal Medicine – WR
King Abdulaziz Medical City – National Guard Health Affairs
Grant-Recipient of KAIMRC (RC10/134 J); ClinicalTrials.gov NCT01561885

2. What is CHAMP-Path?
Patient
Physician
Nurse
Social
Worker
Patient
Educator
Clinical
Nutritionist
Pharmacist
Grant-Recipient of KAIMRC (RC10/134 J); ClinicalTrials.gov NCT01561885

3. What is a Clinical Pathway?
Plan of Care
Patient
Admission
Pharmacist
Discharge
Doctor
Nurse
Social
Worker
Patient
Educator
Nutritionist
Day 1 Day 2 Day 3 Day 4 Day 5

4. Previous Studies
The Cochrane Library 2010, Issue 7

6. Pathway Care is different from Usual Care in
terms of length of stay for Acute Kidney Injury.
Pragmatic
RCT
Study Design
Parallel Single
Blind
1 Chertow et al. J Am Soc Nephrol 16: 3365-3370, 2005
Alternate
Hypothesis
Sample Size
Calculation
Size Power Alpha LOS1 Reduction in
LOS (days)
38 patients 80% 5% 5 ±1.8 2

7. LOS
Decrease
by 2 days
Primary Objective
Chertow et al. J Am Soc Nephrol 16: 3365-3370, 2005
Pathway Care
vs.
Usual Care

8. Secondary Objectives
In-hospital Mortality 30-Day Readmission
Determinants of LOS Patient Centeredness

9. On-call Medical
Residents Eligibility Criteria
Written Informed
Consent
Patient
Randomization &
Allocation
Usual Care
or
Pathway Care*
Admission
CTU 1 or
CTU 2*
Usual Process
or
Pathway Referral*
Multidisciplinary
Healthcare Team
Notified*
Pathway Care
Applied*
Methods
(*) Pathway Care

10. Eligibility Criteria
1
1 AKIN Criteria, Critical Care. 2007; 11(2):R31
1

13. Baseline Characteristics

14. Intention to Treat Analysis
4.96
4.80
Usual (n=20) Pathway (n=18)
(p= 0.77)
4 4.2 4.4 4.6 4.8 5
Median LOS (days)

15. Per Protocol Analysis
Usual (n=17) Pathway (n=12)
3.12
4.63
(p= 0.18)
0 1 2 3 4 5
Median LOS (days)

16. Secondary Outcomes
0 Patients
In-hospital Mortality
30-Day Readmission

17. LOS
Determinants of LOS
Improved
Creatinine
Levels
Ultrasound
Predictive
Creatinine (p= 0.39)
Ultrasound (p= 0.54)

18. Patient Satisfaction with Care
134
140
200
180
160
140
120
100
80
60
40
20
0
Mean Score
Usual (n=12) Pathway (n=11)
(p= 0.502)
Care Type

19. Are Pathways Effective in
Acute Kidney Injury?

20. Conclusions
Pathway
Care
Usual
Care
CHAMP-Path
Ongoing
Trials
Per Protocol Analysis
Clinical
Effectiveness
Suggestive

21. Pitfalls
Pathway
Care
Usual
Care
Contamination
Pathway Outcomes
Pathway Adherence
Community-acquired
Hospital-acquired
Critically-ill
Supportive Care

22. Coauthors
Medicine
Dr. Salhah AlSulami Dr. Raad AlWithenani Dr. Osamah Hakami
Dr. Thamer AlAifan Dr. Abdullah AlMalki Dr. Saliman Karsou
Dr. Zuhair Abunijem Dr. Mohammad Qureshi Dr. Mohammad Balla
Dr. Rehan Qureshi Dr. AbdulHameed Gasim Dr. Zeyad Zahrani
Dr. K.H.Mujtaba Quadri
Quality Management Pharmacy Nursing
Ms. Jani Hafez Dr. Sherine Ismail Ms. Jane Thomson
KAIMRC-Jeddah
Ms. Doha AlMadani Dr. Oyindamola Yusuf
Dr. Muhammad Amir Siddiqui Ms. Maryam Khalil
Acknowledgements
All Medical Residents, General Internal Medicine CTU Consultants,
Nursing Department, Pharmaceutical Care Department, Quality Management,
Health Promotions Department, Clinical Nutrition Department,
Medical Ward Unit Assistants, Medical Records Department, KAIMRC, and Department of Medicine