Multi-Disciplinary Kidney Stone Clinics are Associated With Lower Health Care Utilization in the PEDSnet Learning Health Network
Jonathan S. Ellison, MD1, Christopher B. Forrest, MD PhD2, Mitchell G. Maltenfort, PhD2, Kyle Rove, MD3, Christina Ching, MD4, Ahmed Bani-Hani, MD5, Nicolas Fernandez, MD PhD6, Douglas Coplen, MD7, Gregory E. Tasian, MD MSc MSCE2.
1Children's Wisconsin, Milwaukee, WI, USA, 2Children's Hospital of Philadelphia, Philadelphia, PA, USA, 3Children's Hospital of Colorado, Aurora, CO, USA, 4Nationwide Children's Hospital, Columbus, OH, USA, 5Nemours duPont Children's Hospital, Wilmington, DE, USA, 6Seattle Children's Hospital, Seattle, WA, USA, 7St. Louis Children's Hospital, St. Louis, MO, USA.
BACKGROUND: Multidisciplinary kidney stone clinics have been proposed to benefit children with nephrolithiasis by improving care coordination and secondary prevention. However, development and implementation of these clinics are resource intensive and little comparative evidence exists regarding their benefits. Using data from PEDSnet, a pediatric learning health network, we assessed health care utilization of children with nephrolithiasis during timeframes of an active multidisciplinary kidney stone clinic as compared to timeframes without such a clinic.
METHODS: We conducted a retrospective cohort study of individuals < 24 years of age with nephrolithiasis cared for at one of six PEDSnet hospitals from January 2009 to August 2020. PEDSnet is a multi-institutional clinical research network that has harmonized the diverse EHR systems of participating institutions to assemble a longitudinal database for >7 million children by transforming source institutional EHR data into the OMOP common data model. The comparator was presence or absence of a multidisciplinary kidney stone clinic at time of cohort entry date, with date of clinic initiation and cessation (if applicable) provided by each site. Outcomes of interest include emergency department (ED) visits and any physician visit up to the receipt of surgical intervention as well as surgical interventions using generalized linear modeling adjusting for age, race/ethnicity, gender, date of cohort entry, date of first surgery (if applicable), distance to hospital, number of non-genitourinary chronic condition types, institution, and prescription of kidney stone promoter or inhibitor medications.
RESULTS: A total of 9,945 unique patients were identified with a mean age of 12.8 (+ 5.6) years and a mean follow-up of 2.4 (+ 2.6) years. A total of 5 institutions maintained a multidisciplinary kidney stone clinic during the study period and 4,049 (40.7%) children were cared for during the multidisciplinary kidney stone clinic interval. The cohort was majority female (N=5,288, 53.2%) and predominantly of white race/ethnicity (N=7,326, 73.7%). Monogenic kidney stone disease was noted in 115 (1.2%) patients while non-genitourinary chronic conditions were noted in 4,722 (47.5%) patients. A total of 1,764 (17.7%) of patients required surgical intervention. The presence of a multidisciplinary kidney stone clinic was associated with a lower incidence of both any physician visit (0.91, 95% CI 0.87-0.94 ) and ED visit (0.84, 95% CI 0.73-0.96) prior to an index surgical intervention or study end date. (Table)
CONCLUSIONS: Multidisciplinary kidney stone clinics show reduced physician and acute care visits across 6 pediatric medical centers. These data suggest benefit to such clinics in the coordination of care, potentially allowing more timely access to specialists during acute kidney stone episodes and in the prevention of symptomatic events. Further work is needed to clarify the structures of multidisciplinary kidney stone clinics that provide the most benefit to patients and their families. 
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