The social determinants of health have a large impact on health. For example, neighborhood socioeconomic deprivation is associated with increased risk of medication non-adherence, graft failure, and death in children after liver transplant. In order to address these socioeconomic inequities in outcomes, a more granular understanding of how the social determinants of health impact outcomes is needed. In this observational prospective cohort, caregivers of children undergoing liver transplantation will complete surveys and undergo in-depth, qualitative interviews. The survey will assess comprehensively for the social determinants of health (e.g. material economic hardship, health literacy, social connectedness, primary care quality, etc). The qualitative interviews will identify barriers and facilitators that socioeconomically deprived children/families have to obtaining the ideal outcome and identify health system opportunities to integrate social needs and medical care. Data will be linked to an existing prospective cohort study (The Society for Pediatric Liver Transplant registry) to assess the impact of social risk on outcomes after transplant. Healthcare providers who take care of children undergoing liver transplant will also be included in the qualitative interviews. The goal of including this group in the study is to determine the health systems barriers and facilitators to social needs screening and intervention.
Study Type
OBSERVATIONAL
Enrollment
500
Children's Hospital Los Angeles
Los Angeles, California, United States
Lucile Packard Children's Hospital
Palo Alto, California, United States
University of California San Francisco
San Francisco, California, United States
Children's Healthcare of Atlanta
Atlanta, Georgia, United States
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
UPMC Children's Hospital of Pittsburgh
Pittsburgh, Pennsylvania, United States
Children's Medical Center Dallas
Dallas, Texas, United States
Seattle Children's Hospital
Seattle, Washington, United States
Number of days hospitalized within 90 days after transplant, including the initial transplant hospitalization
Time frame: 90 Days
Episodes of acute cellular rejection
Time frame: 1 Year
Ideal Outcome-3 (IO-3)
The ideal outcome measure is a composite measure of morbidity after transplant defined as alive, ALT and GGT \<50, normal GFR, no non-liver transplants, no cytopenias, and no PTLD.
Time frame: 3 Years
Readmission within 90 days after transplant
Time frame: 90 Days
Episode of biopsy-proven acute cellular rejection within 90 days after transplant
Time frame: 90 Days
Episode of re-transplantation
Time frame: 3 Years
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