253 - Standardization of care for children with new onset nephrotic syndrome

Poster Number: 253
Publication Number: 253.452

Jacob C. Little, Seattle Children's, Seattle, WA, United States; Machi Kaneko, Seattle Children's, Seattle, WA, United States; Michelle Denburg, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Lynsey Cecere, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Benjamin L. Laskin, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Rebecca R. Scobell, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Dayna Mazza, Children’s Hospital of Philadelphia, Philadelphia, PA, United States; Joseph Flynn, Seattle Children's, Seattle, WA, United States; Karyn Yonekawa, Seattle Children's, seattle, WA, United States

Background: The Glomerular Learning Network (GLEAN) is a collaborative of nine pediatric institutions whose mission is to improve the health and well-being of children with glomerular diseases by increasing sustained remission and decreasing complications. To achieve these goals, GLEAN launched a Quality Improvement initiative for new onset nephrotic syndrome consisting of a standardized clinical pathway and “Smart Bundle” (SB). This SB standardizes visit timing, initial medication regimens, patient/family education, and dietary counseling.

Objective: 1. To describe compliance with individual SB components: number of patients who received an educational packet, nutrition counseling, immunization review, and tuberculosis (TB) screening at 2 GLEAN sites, Children's Hospital of Philadelphia (CHOP) and Seattle Children's Hospital (SCH).
2. To describe compliance with all SB components at SCH only. The SMART Aim was 80% compliance of 100% of the SB components for each case of new onset nephrotic syndrome by 12/31/2022.

Design/Methods: GLEAN developed a SmartForm used by providers and nurses which populates an electronic health record registry at both sites. In a primary analysis, registry data from CHOP (12/2020-12/2022) and SCH (7/2022-12/2022) were combined to evaluate four SB metrics: education, nutrition counseling, immunization review, and TB screening.  
A secondary prospective analysis of SB compliance was then completed for SCH. The additional components audited included: initial outpatient visit within 5 days of diagnosis, standardized steroid dosing, and 4-week follow-up visit completed.

Results: In the primary analysis, 51 patients were included. 86% received an educational packet, 90% had nutrition counseling, 80% had immunization review, and 92% had TB screening.
In the secondary analysis, 3/10 (30%) patients were compliant with all SB components. Reasons for missed opportunities included: SmartForm not completed (50%), vaccine records not reviewed (10%), and TB screening not completed (10%).

Conclusion(s): Standardization of care for children with nephrotic syndrome has historically been difficult. This QI project demonstrates that standardization of care across multiple large subspecialty centers is possible using a nephrotic syndrome SB. Future work across all GLEAN centers will determine which SB components may be most impactful on patient outcomes.