Impact of social complexity on outcomes in cystic fibrosis after transfer to adult care

Crowley, Erin; Bosslet, Gabriel T.; Khan, Babar; Ciccarelli, Mary; Brown, Cynthia

doi:10.1002/ppul.23997

Cited by 10 publications

(7 citation statements)

References 25 publications

(34 reference statements)

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“…Representativeness of study population. Five studies 53,[57][58][59][60] used pre-transition groups that were likely not representative of the larger population with the condition (e.g. they used data from a single clinic).…”

Section: Study Characteristicsmentioning

confidence: 99%

Transition of children with life-limiting conditions to adult care and healthcare use: a systematic review

et al. 2021

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Background Improved survival has led to increasing numbers of children with life-limiting conditions transitioning to adult healthcare services. There are concerns that transition may lead to a reduction in care quality and increases in emergency care. This review explores evidence for differences in health or social care use post- versus pre-transition to adult services. Methods MEDLINE, EMBASE, CINAHL, PsychINFO and Social Science Citation Index were searched. Studies published in English since 1990 including individuals with any life-limiting condition post- and pre-transition and reporting a health or social care use outcome were included. Data were extracted and quality assessed by one reviewer with 30% checked by an independent reviewer. Results Nineteen papers (18 studies) met the inclusion criteria. There was evidence for both increases and decreases (post- versus pre-transition) in outpatient attendance, inpatient admissions, inpatient bed days and health service costs; for increases in Emergency Department visits and for decreases in individuals receiving physiotherapy. Conclusions Evidence for changes in healthcare use post- versus pre-transition is mixed and conflicting, although there is evidence for an increase in Emergency Department visits and a reduction in access to physiotherapy. More high-quality research is needed to better link changes in care to the transition. Impact Evidence for changes in healthcare use associated with transition to adult services is conflicting. Emergency Department visits increase and access to physiotherapy decreases at transition. There are marked differences between care patterns in the United States and Canada.

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Section: Study Characteristicsmentioning

confidence: 99%

Transition of children with life-limiting conditions to adult care and healthcare use: a systematic review

et al. 2021

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“…At one institution, the burden of care due to medical complexity was found to lead to higher utilization of both health care visits and hospitalization surrounding transition to adult care . Social complexity can also add to burden and adherence.…”

Section: Patient‐reported Outcomes/prioritiesmentioning

confidence: 99%

“…Social complexity can also add to burden and adherence. Using a novel social complexity scale, involving assessment of overall health, family, behavioral and mental health, education and special issues, increasing social complexity was associated with an increase in hospitalization post transfer to adult care …”

Section: Patient‐reported Outcomes/prioritiesmentioning

confidence: 99%

“…10 At one institution, the burden of care due to medical complexity was found to lead to higher utilization of both health care visits and hospitalization surrounding transition to adult care. 11 Social complexity can also add to burden and adherence. Using a novel social complexity scale, involving assessment of overall health, family, behavioral and mental health, education and special issues, increasing social complexity was associated with an increase in hospitalization post transfer to adult care.…”

Section: Mental Healthmentioning

confidence: 99%

“…Using a novel social complexity scale, involving assessment of overall health, family, behavioral and mental health, education and special issues, increasing social complexity was associated with an increase in hospitalization post transfer to adult care. 11 On top of the high burden of care and increasing medical complexity, fatigue and sleep disorders can also decrease QoL and lead to poor adherence. In an assessment of children with CF, ages 7 to 18 years, compared with controls, no differences were found in actigraphy when used as a marker of sleep.…”

Section: Mental Healthmentioning

confidence: 99%

See 2 more Smart Citations

Cystic fibrosis year in review 2018, part 2

Savant

McColley

2019

Pediatric Pulmonology

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Social complexity negatively influences lung function in cystic fibrosis after transfer to adult care

Crowley

Bosslet

Khan

et al. 2019

Pediatric Pulmonology

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BackgroundSeveral nongenetic factors, such as socioeconomic status, environmental exposures, and adherence have been described to have an impact on outcomes in cystic fibrosis (CF).ObjectiveTo determine the effect of social complexity on the % predicted forced expiratory volume (ppFEV1) before and after transfer to adult care among adolescents with CF.MethodsRetrospective, single center, cohort study included all patients with CF who were transitioned into adult care between 2005 and 2015 at Indiana University. Social complexity (Bob's level of social support, [BLSS]) was collected at transfer. Linear mixed regression models assessed the relationship between ppFEV1 decline over time and BLSS with other covariates.ResultsThe median age of the patients (N = 133) at the time of transfer was 20 years (interquartile range: 19‐23). Overall, there was a decline in lung function over time in our population (ppFEV1 at 24 months pretransfer 77 ± 20%, ppFEV1 at 24 months, posttransfer 66 ± 24%; P < .001). The relationship between BLSS and ppFEV1 became more negative over time, even after adjusting for other covariates.ConclusionSocial complexity is strongly associated with lung function decline after transfer to adult care.

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Impact of social complexity on outcomes in cystic fibrosis after transfer to adult care

Cited by 10 publications

References 25 publications

Transition of children with life-limiting conditions to adult care and healthcare use: a systematic review

Transition of children with life-limiting conditions to adult care and healthcare use: a systematic review

Cystic fibrosis year in review 2018, part 2

Social complexity negatively influences lung function in cystic fibrosis after transfer to adult care

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