The Guided Transfer of Care Improves Adult Clinic Show Rate

Abstract

Objective: Every year, 500,000 youths in the U.S. with chronic disease turn 18 years of age and eventually require transfer to adult subspecialty care. Evidence-based interventions on the organization of transfer of care are limited, although engagement and retention in adult clinic are considered appropriate outcomes. Sustained continuity of care improves patient satisfaction and reduces hospitalization. Methods: We conducted a prospective, nonrandomized cohort study of patients with pediatric endocrine conditions, age 16 to 26 years, enrolled upon referral to the adult endocrine clinic of a physician trained in both adult and pediatric endocrinology (Med+Peds endocrinologist). Patients differed based on whether their referral originated from another pediatric endocrinologist (traditional transfer) or if the Med+Peds endocrinologist previously saw the patient in his pediatric endocrine clinic (guided transfer). Rather than relying on arbitrary age criteria, guided transfer to adult clinic occurred when physician and patient considered it appropriate. The primary outcome was show rate at the first and second adult visits. Results: Of 36 patients, 21 were referred by another pediatric endocrinologist and 15 underwent guided transfer. For traditional transfer, show rate to the first and second visit was 38%, compared to 100% in the guided transfer group ( P = .0001). Subgroup analysis of 27 patients with diabetes revealed that both groups had similar initial hemoglobin A1c ( P = .38), and the guided transfer group maintained hemoglobin A1c. Conclusion: Most traditional transfers were unsuccessful. Guided transfer was significantly more effective, with every patient successfully transferring, and could be implemented with adult endocrinologists willing to see patients in the pediatric clinic. Abbreviations: DKA = diabetic ketoacidosis; HbA1c = hemoglobin A1c; Med+Peds = Internal Medicine and Pediatrics

Patterns and rates of confirmed transfer of care of patients with juvenile idiopathic arthritis at a tertiary paediatric rheumatology centre

“…More concerningly still, a significant proportion of these patients had polyarthritis, which is known to be associated with poorer long‐term outcomes than other JIA subtypes, with higher rates of severe limitation of function and disability in adulthood 8 . Our findings are consistent with studies in other tertiary centres in which suboptimal transfer of care was found to occur in 34–59% of patients with JIA and other chronic illnesses 5,9–12 . Taken together, these data highlight the importance of having mechanisms in place to ensure ongoing care has been established when transitioning JIA patients to adult care.…”

“…We found that the use of ‘backstop’ appointments – appointments at our centre scheduled intentionally after the estimated date of initial adult review – more than doubled the rate of documented transfer of care. To our knowledge, this is the first study to demonstrate this and provides evidence to support their use, particularly for services that do not have the capacity to implement guided transfer of care models in which paediatric specialists participate as patients are introduced to adult providers and corresponding models of care 11 …”

“…To our knowledge, this is the first study to demonstrate this and provides evidence to support their use, particularly for services that do not have the capacity to implement guided transfer of care models in which paediatric specialists participate as patients are introduced to adult providers and corresponding models of care. 11 Another interesting finding of this audit is that just over one-third of JIA patients at our centre are not referred for adult care. Concerningly, in 61.9% of cases this occurred as a result of loss to follow up in the context of repeated failure to attend appointments or patients electing to withdraw from care.…”

Transition von Jugendlichen mit Diabetes in die Erwachsenenbetreuung – eine Expertenbefragung

“…Bessere Zusammenarbeit/Kommunikation mit Erwachsenenmedizinern [24,25]. Auch die Daten von Studien aus den USA, Australien, Israel, Spanien und Italien weisen darauf hin, dass eine systematische Transition zu einer Verbesserung der HbA 1c -Werte führen kann [7,[26][27][28][29].…”

We mind your step: understanding and preventing drop-out in the transfer from paediatric to adult tertiary endocrine healthcare

“…The entire dynamic process in which the paediatric patient is guided towards AC is called ‘transition’, whereas ‘transfer’ is the moment when the patient leaves PC and AC takes over. The transfer of adolescents from PC to AC is a crucial but vulnerable step in the care of adolescents with a chronic disorder ( 4 , 5 ). Previous studies have shown that up to 25% of young adults with endocrine disorders are lost to follow-up after moving out of paediatric care ( 6 , 7 , 8 ).…”