Background and objectives Low health-related quality of life is associated with increased mortality in patients with ESRD. However, little is known about demographic and clinical factors associated with health-related quality of life or its effect on outcomes in adults with CKD.Design, settings, participants, & measurements Data from 3837 adult participants with mild to severe CKD enrolled in the prospective observational Chronic Renal Insufficiency Cohort and Hispanic Chronic Renal Insufficiency Cohort Studies were analyzed. Health-related quality of life was assessed at baseline with the Kidney Disease Quality of Life-36 and its five subscales: mental component summary, physical component summary, burden of kidney disease (burden), effects of kidney disease (effects), and symptoms and problems of kidney disease (symptoms). Low health-related quality of life was defined as baseline score .1 SD below the mean. Using Cox proportional hazards analysis, the relationships between low health-related quality of life and the following outcomes were examined: (1) CKD progression (50% eGFR loss or incident ESRD), (2) incident cardiovascular events, and (3) all-cause death.Results Younger age, women, low education, diabetes, vascular disease, congestive heart failure, obesity, and lower eGFR were associated with low baseline health-related quality of life (P,0.05). During a median follow-up of 6.2 years, there were 1055 CKD progression events, 841 cardiovascular events, and 694 deaths. Significantly higher crude rates of CKD progression, incident cardiovascular events, and all-cause death were observed among participants with low health-related quality of life in all subscales (P,0.05). In fully adjusted models, low physical component summary, effects, and symptoms subscales were independently associated with a higher risk of incident cardiovascular events and death, whereas low mental component summary was independently associated with a higher risk of death (P,0.05). Low health-related quality of life was not associated with CKD progression.Conclusions Low health-related quality of life across several subscales was independently associated with a higher risk of incident cardiovascular events and death but not associated with CKD progression.

Objective: To test the psychometric soundness of a teamwork climate survey in labor and delivery, examine differences in perceptions of teamwork, and provide benchmarking data.Design: Cross-sectional survey of labor and delivery caregivers in 44 hospitals in diverse regions of the US, using the Safety Attitudes Questionnaire teamwork climate scale.Results: The response rate was 72% (3382 of 4700). The teamwork climate scale had good internal reliability (overall a ¼ 0.78). Teamwork climate scale factor structure was confirmed using multilevel confirmatory factor analyses (CFI ¼ 0. IntroductionAfter the release of To Err is Human, 1 many healthcare institutions and organizations began the process of moving safety improvement efforts forward. One principle in this report was the 'promotion of effective team functioning.' The American College of Obstetricians and Gynecologists (ACOG) responded with a set of safety-related objectives for clinical providers to follow in daily practice. 2 One objective stressed commitment to a patient safety culture through the daily practice of teamwork, communication, collaboration and strong leadership for providers.Effective teamwork is critical in high-risk settings where individuals interact with other persons to perform their job. In aviation, plane crashes resulting from flight crew discord prompted development of crew resource management (CRM) training to address team climate and improve performance. 3,4 In healthcare, researchers have identified and are investigating group hierarchy, stressful work environments, poor communication and varying perceptions of what comprises a team as some barriers to effective teamwork. 5,6 One outcome of poor team climate is medical error. The Joint Commission on Accreditation of Healthcare Organization's (JCAHO) sentinel event investigation in labor and delivery (L&D) found poor communication as a root cause in over 80% of perinatal deaths and injuries. 7 Additionally, the leading root cause of perinatal deaths and injuries tracked by JCAHO was communication breakdowns, which was cited in over 80% of events. 8 In another study, poor teamwork was attributed to 40% of maternal deaths and 45% of near miss morbidities. 9 Team performance is important in L&D because a normal situation can transition to an emergency rather quickly. A rescue team must assemble quickly, communicate clearly and collaborate effectively to avoid needless morbidity or mortality. 10,11

Introduction: Individuals with chronic kidney disease (CKD) generally have poor participation in self-care. We hypothesized that greater kidney disease knowledge and health literacy would associate with better self-care. Methods:We enrolled 401 participants with non-dialysis-dependent CKD from one academic center in this cross-sectional study. Validated surveys were used to assess health literacy level (inadequate vs. adequate; Rapid Estimate of Adult Literacy in Medicine), perceived kidney disease knowledge (Perceived Kidney Disease Knowledge Survey [PiKS]), objective kidney disease knowledge (Kidney Disease Knowledge Survey [KiKS]), and a CKD self-care measure was constructed as the sum of self-reported self-care behaviors using the adapted Summary of Diabetes Self-Care Activities Assessment. The association between health literacy level, PiKS scores, KiKS scores, and the CKD self-care measure was assessed with multivariable adjusted linear regression models.Results: Participants had a mean age of 57 years and 17.7% had inadequate health literacy. PiKS scores were positively associated with the CKD self-care measure (b ¼ 1.05, 95% confidence interval [CI] 0.50-1.63), and a positive trend was observed for KiKS scores and the CKD self-care measure (b ¼ 0.30, 95% CI: À0.12 to 0.72). Health literacy was not associated with CKD self-care measure. Conclusion:Objective kidney disease knowledge is likely necessary, but not sufficient for self-care and may depend on the level of health literacy. Perceived kidney knowledge may offer a novel target to assess patients at risk for poor self-care, and be used in targeted educational interventions.

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Background Limited research exists on physician-delivered education interventions. We examined the feasibility and impact of an educational tool on facilitating physician-patient kidney disease communication. Study Design Pilot feasibility clinical trial with a historical control to examine effect size on patient knowledge and structured questions to elicit physician and patient feedback. Setting & Participants Adults with chronic kidney disease (CKD) stages 1–5, seen in nephrology clinic. Intervention One page educational worksheet, reviewed by physicians with patients. Outcomes Kidney knowledge between patient groups and provider/patient feedback. Measurements Patient kidney knowledge was measured using a previously validated questionnaire compared between patients receiving the intervention (April–October 2010) and a historical cohort (April–October 2009). Provider input was obtained using structured interviews. Patient input was obtained through survey questions. Patient characteristics were abstracted from the medical record. Results 556 patients were included, with 401 patients in the historical cohort, and 155 receiving the intervention. Mean age was 57 ± 16 (SD) years, with 53% male, 81% White, and 78% CKD stages 3–5. Compared to the historical cohort, patients receiving the intervention had higher adjusted odds of knowing they had CKD (adjusted OR, 2.20; 95% CI, 1.16–4.17; p=0.01), knowing their kidney function (adjusted OR, 2.25; 95% CI, 1.27–3.97; p=0.005), and knowing their stage of CKD (adjusted OR, 3.22; 95% CI, 1.49–6.92; p=0.003). Physicians found the intervention tool easy and feasible to integrate into practice and 98% of patients who received the intervention recommended it for future use. Limitations Study design did not randomize patients for comparison and enrollment was performed in clinics at one center. Conclusions In this pilot study, a physician delivered education intervention was feasible to use in practice, and was associated with higher patient kidney disease knowledge. Further examination of physician delivered education interventions for increasing patient disease understanding should be tested through randomized trials.