Urologic Burden of Care Outside of Scheduled Clinic Visits in Infants with Spina Bifida
Michael Daugherty, MD, MHI, Katie Mueller, NP, Paul Campbell, MD, Kiersten Craig, MD, Brian VanderBrink, MD.
Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Introduction: Patients with spina bifida have complex medical needs that require management by multiple specialties. There is significant urologic involvement especially at a younger age when families may be getting used to caring for their child. Many concerns and questions that arise are addressed outside of regular scheduled clinic appointments. The aim of this study was to quantify and characterize these communications within the first 2 years of life in order to identify patient factors associated with increased care needs outside of scheduled visits. Methods: As part of an ongoing quality improvement project, all patients that presented to the multidisciplinary spina bifida clinic that were born after 3/1/2020 were identified. Baseline demographic information was collected. A review of the EHR was performed and identified all encounters made with the urology office separate from any scheduled clinic appointments. Information regarding type of communication, patient age at time of encounter and reason for encounter was collected for each encounter. X-bar/S charts were created with rational subgrouping to identify differences between patient populations when looking at encounters occurring during each month of life. Results: There were a total of 56 patients seen in our spina bifida clinic that fit inclusion criteria. Seventeen patients were started on anticholinergic therapy during the first 2 years of life. A total of 532 encounters were created within the EHR outside of scheduled clinic visits for all patients. Patients on anticholinergics represented 311 encounters and those not on anticholinergics were responsible for 221 encounters. The reasons for encounters were different when stratified according to anticholinergic usage (p=0.003, Figure 2), but no difference when stratified by shunt status (p=0.4) or closure timing (p=0.6). When subgrouping according to anticholinergic status there was a stark difference in encounters for each month of life, but these differences were not seen according to shunt status or closure timing (Figure 1).
Conclusion: Infants and toddlers with spina bifida that are started on anticholinergics have significantly increased communication with the urology office outside of scheduled clinic visits. The increased communications are seen even in the younger months prior to starting anticholinergics. These patients represent a more complex population that earlier intervention may help limit the burden of care for families.
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