BACKGROUND: With the rising rate of pediatric stone disease, post-operative follow-up after pediatric kidney stone surgery has never been more important to enable further work-up and preventative counselling. Methods to improve adherence to follow-up should be sought. We compared the impact of different protocols at two different institutions for scheduling post-operative follow-up (clinic-initiated vs. patient-initiated) on attendance of office visit and completion of imaging. We hoped to identify potential interventions to improve patient adherence with post-operative recommendations. METHODS: Patients undergoing kidney stone surgery at two institutions (Children’s Hospital of Alabama [COA]/Nationwide Children’s Hospital [NCH]) while participating in the Pediatric KIDney Stone (PKIDS) Care Improvement Network Trial were included for review. At COA, patients are provided the pediatric clinic scheduling number at discharge from stone surgery to initiate scheduling their postoperative urology office visit and imaging (“patient-initiated”). At NCH, dedicated scheduling staff arranges follow-up office visit and imaging with dates given to family at surgery discharge (“clinic-initiated”). Charts were reviewed at each institution to identify rates of office visit and imaging attendance within 16 weeks. Fischer’s exact test compared office visit adherence and imaging completion between institutions. RESULTS: 233 patients were included: 76 from COA and 157 from NCH. There was significantly less adherence to attending postoperative office visits and acquiring postoperative imaging at COA (“patient-initiated”) than NCH (“clinic-initiated”) (54% vs. 86%; p<0.001 and 51% vs. 80%; p<0.001, respectively). There was not a significant difference between institutions in distance traveled to hospital from patient home address and patient insurance status, age, or gender (Table 1). CONCLUSIONS: Follow-up appears improved if appointments are scheduled for patients by the clinic compared to being dependent on patient initiation. In our growing appreciation for social determinants of health that may impact patient care, it appears clinic initiated scheduling may help improve medical adherence to follow-up visits and imaging after pediatric stone surgery.
