TOP 41 - Impact of a Post-PICU Follow-up Clinic on Health Disparities following PICU Admissions

Publication Number: 3771.TOP 41

Adam DeLong, MassGeneral Hospital for Children, Cambridge, MA, United States; Sarah Murphy, Harvard Medical School, Boston, MA, United States

Background: Healthcare-related disparities exist in the utilization of pediatric intensive care unit (PICU) resources and in outcomes following PICU admission. These disparities include differences in health-related quality of life, post-discharge healthcare utilization, and may impact development of pediatric post-intensive care syndrome (PICS-p), a phenomenon defined by newly developed functional impairment following discharge from intensive care.

In 2012, our institution introduced a post-PICU follow-up clinic with goals of early identification and treatment of PICS-p and connection of patients to appropriate resources. Patients are seen 4-6 weeks post-discharge from the PICU. The clinic includes assessment by a pediatric intensivist, social worker, physical medicine and rehabilitation physician, and neuropsychologist.

We are conducting a retrospective study of patients seen in this clinic to assess the clinic's role in supporting recovery and improving patient outcomes. Particularly, we are examining the role of social determinants of health on post-PICU clinic patients’ needs and treatment. We hypothesize that patients with higher SER will utilize the post-PICU clinic more frequently and that clinic visits for patients with higher SER will reveal a greater number of unmet needs and required services.

Objective: To evaluate utilization, clinical performance, and patient outcomes of a post-PICU follow-up clinic as stratified by patient SER. This analysis is crucial to developing and evaluating post-PICU care models that are equitable and effectively address the unique needs of diverse patient populations.

Design/Methods: Subjects include patients seen in the post-PICU clinic and consented for study inclusion.

Data collected includes patient-identified social health needs, race/ethnicity, primary language, Childhood Opportunity Index (COI) via zip code, and insurance status.

Data have been collected via retrospective chart review and entered into a REDCap database utilizing an IRB already in place.

After defining high risk groups, e.g. patients with one or more identified risk factors related to social determinants of health, we will employ quantitative measures to compare clinic utilization, performance, and outcomes between high and low risk patient populations including:

Access/Equity: rates of clinic patient enrollment, no-show, and attendance.

Patient Outcomes: measures of change in functional/neurocognitive status, self-reported quality of life, and acute stress symptoms.

Clinical Performance: number of new diagnoses, prescriptions, referrals, and other clinic interventions.