Impact of a Health Care Transition (HCT) Clinic on Health Outcomes in Patients with Kidney Diseases: A Single-Center Experience

Background: HCT from pediatric to adult focused care in patients with renal disease can be a challenging process. Inadequate HCT can cause interruption in continuity of care,which can lead to poor health outcomes like disease progression. A HCT clinic can be effective tool in building trust, communication and better health outcomes in adolescents and young adults (AYA). This abstract highlights the impact of a HCT on patients who utilized this at a Children’s hospital in collaboration with an affiliate hospital in southwest USA. Methods: We included patients who utilized the HCT clinic from 2021-2023 comprising of two visits (pediatric and adult clinics) to achieve thorough hand-off. We collected data on health related outcomes by manual review of EHRs. Our outcomes were: 1. Retention in adult renal care as measured by regular follow up with adult provider 2. Adequate communication between patient and provider measured via MyChart utilization 3. Significant events by noting adverse events such as hospitalization, renal transplant rejection & unplanned pregnancies. Results: 29 patients utilized the HCT clinic (8 M, 21 F). 16(55%) with renal transplants, 7(24%) with Lupus Nephritis and 6(20%) with CKD. Retention in adult renal care was good 96%(28 out of 29)followed up regularly with their renal provider and only one patient was lost to follow up. All patients (100%) utilized MyChart to communicate with their adult renal providers.There were adverse events: 2(6%) patients who experienced complications of renal transplant requiring hospitalization and disease management. Patients were sent to transplant team in the same hospital for closer monitoring. 3 female patients got pregnant. Conclusion: We found that AYA can benefit with HCT clinic. Overall retention in adult renal care was favorable and majority of the patients maintained good communication with their pediatric and adult renal providers. Outcomes for patients utilizing the HCT clinic appear positive with only 2 patients developing transplant rejection. In the future,we plan to look in to women’s health especially after HCT with pregnancy and disease progression. Health Outcomes from HCT clinic - 1) Retention in adult health care 28/29 patients followed up with adult renal provider1 patient with ESRD – transitioned to local dialysis unit1 patient with insurance issues transitioned to in-network renal1 patient was lost to follow up 2) Communication between patient and provider 29/29 patients active on my chart 3) Significant events Two patients with transplant complication transitioned to transplant team in same adult hospitalThree patients had pregnancies