Healthcare Utilization for Pediatric Solid Organ Transplant Recipients: An Examination from Oneflorida Clinical Research Consortium

Background: Solid organ transplantation (SOT) is a life-saving treatment for pediatric patients with most end-stage organ failure. Due to the chronic and resource-intensive nature of organ transplantation treatment, it is crucial to examine the feature of healthcare utilization among these patients. Transplant social workers must address psychological and social risk factors which may contribute to poor post-transplant health outcomes. Increased contact with the transplant care team during periods of care can be identified through examining healthcare utilization of these patients and their families. Given the limited research in this area, the purpose of this paper was to examine healthcare utilization among a state-wide sample of pediatric SOT patients.

Methods: The dataset analyzed in this study was from OneFlorida Clinical Research Consortium (OneFL), a robust and state-wide patient-level electronic health record database from public and private health care systems. OneFL data was used to identify 2247 pediatric heart, kidney, and liver transplant procedures between 2011 through 2020 across Florida state. Patient-level data such as demographic, encounters, and procedures are analyzed. Patients aged 0 to 18 years old when they had their first SOT procedures were identified by diagnostic codes. Descriptive statistics were used to report the specific frequencies and distributions of the demographics, as well as encounters and length of stays for pediatric organ transplant populations. Means and standard deviation for continuous variables, and frequencies and percentages for categorical data were reported.

Results: A total of 213 pediatric SOT recipients were identified. A majority of the patients were male (55.4%), with an average age at the time of transplant of 8.59 years (SD = 6.61), and most of them were adolescents (13-18 years old, n=78, 36.60%). Over half were White (n=114, 53.50%) and were not Hispanic (n=160, 75.1%). They underwent heart (n=133, 62.4%), kidney (n=63, 29.6%), liver (n=14, 6.6%), and lung (n=3, 1.4%) SOT. From these patients, 69343 unique medical encounters were identified, and outpatient ambulatory accounted for the largest portion (n=64532, 93.1%). Pediatric patients had the heaviest demand for healthcare services in the first year following SOT (n=20971, 30.24%). 2423 unique length of stay (LOS) records during initial hospitalization for SOT were identified and they ranged from 0 to 650 days (Mean LOS=20.12, SD=51.63). Most LOS were within 50 days (n=2199, 90.76%), the majority of LOS were within 21 days (n=2066, 85.30%), and over half of LOS were less than or equal to 5 days (n=1424, 58.80%).

Conclusion: This retrospective study found the largest proportion of encounters occurred within the first year when pediatric patients underwent SOT. The need for significant healthcare services can exist seven years before the transplantation procedure and last nine years after the surgery. The demands of healthcare utilization happen more frequent in the post-transplant period and last longer than those before SOT. The majority of pediatric SOT patients spent less than 50 days in hospitals. Findings from this study can inform the allocation of healthcare resources, and help the transplant team to provide sufficient support and services for pediatric patients who undergoing SOT.