Pediatric solid organ transplant recipients are medically delicate and present with complex care issues requiring high-level management at home. readiness for discharge. Readiness for hospital discharge was subsequently significantly associated with post-discharge coping difficulty (p = .02) at 3-weeks adherence with Calcitetrol medication administration (p = .03) at 3-months and post-discharge coping difficulty (p = .04) and family management (p = .02) at 6-months post-discharge. The results underscore the important aspect of education and care coordination in preparing patients and families to successfully self-manage after hospital discharge. Assessing parental readiness for hospital discharge is another critical component for identifying risk of difficulties in managing post-discharge care. Calcitetrol Keywords: DLL4 pediatric solid organ transplant discharge transition Introduction Pediatric transplantation is an international effort; 1 540 children in the United States alone in 2013 underwent solid organ transplant (SOT)(1) billing an average of $425 0 for the transplant hospitalization.(2) Hospital readmissions are another costly component to medical care and recent changes in Medicare reimbursement penalize adult hospitals for high readmission rates.(3) Pediatric institutions are similarly focusing on readmission as a quality indicator.(4) In the pediatric population there are a small percentage of medically complex children that account for the majority of hospital admission and costs. Furthermore families of medically complex children with minimal resources including but not limited to access to care and family/caregiver resources may end up with more frequent readmissions.(4) Pediatric Calcitetrol SOT recipients are medically fragile and present with complex care issues requiring high-level management in the home. Parents of hospitalized children including pediatric SOT recipients have reported inadequate preparation for discharge resulting in problems with transition from hospital to home and independently self-managing their child’s complex care needs.(5-8) SOT parents’ understanding of discharge teaching is essential for medication adherence and follow-up care.(9) Inaccurate medication administration and lack of close follow-up with the transplant team can result in unplanned emergency department (ED) visits and inpatient re-hospitalizations including their associated cost.(10) A focus on planned coordinated and supported discharge transition has resulted in decreased hospital readmission rates and cost of care in adult patients.(11-13) There are several projects focused on improving the ability of adult patients and their families to self-manage at home.(11-15) However these national discharge transition projects have not addressed the needs Calcitetrol of chronic illness in children and their families. Our previous work has reported that parents of pediatric SOT recipients with low readiness for hospital discharge subsequently reported more difficulty coping and adhering to the complex continuing care their children require at 3-weeks following hospital discharge.(16) Research on both discharge transition and family transition longitudinally is not presently addressed in the literature. This study extends the earlier research of this study team with the goal of identifying opportunities to enhance discharge transition care and improve the post-discharge experience and chronic illness management of SOT families. Aims The aim of this study was to investigate factors associated with the transition from hospital to home and chronic illness care defined as the first six months following hospital discharge for parents of SOT (heart kidney liver lung or multivisceral) recipients. Specifically our aims were to determine if: Aim 1: Pre-discharge hospital care processes specifically discharge teaching and care coordination are associated with parent perception of readiness for hospital discharge. Aim 2: Parent readiness for hospital discharge lessens primarily three week post-discharge coping difficulty and secondarily later coping difficulties along with family impact adherence to medication administration and medical regimen follow-up and utilization of healthcare resources within the first six months following hospital discharge..