Time to First Completed Visit and Health Care Utilization Among Young Adults Transferring From Pediatric to Adult Rheumatologic Care in a Safety‐Net Hospital

Abstract

Objective. The transfer from pediatric to adult care for young adults is a vulnerable period. Our objectives were to quantify the time between the final pediatric and the first adult visit and to evaluate unscheduled utilization in care and progression to end-stage renal disease (ESRD) or death.Methods. We conducted a retrospective analysis of pediatric patients transferring to a large adult rheumatology clinic. Outcomes included time to first completed adult visit, unscheduled health care utilization (hospitalizations and emergency department [ED] visits), and progression to ESRD or death. Multivariable regression models assessed variables predictive of outcomes of interest.Results. A total of 141 pediatric patients who transferred care were identified: 77% female, 65% Hispanic, and 60% with connective tissue diseases (CTDs). The mean time between final pediatric and first completed adult rheumatology visit was 221 days (range 0-1,207 days). In regression modeling, we found that continued insurance coverage, younger age at referral, and referral from a pediatric rheumatologist were predictive of shorter time to completed adult visit (P < 0.005). Factors associated with hospitalizations and ED visits included CTD diagnosis and Black race (odds ratio [OR] 8.54 [95% confidence interval (95% CI) 1.84-39.58] and 3.04 [95% CI 1.02-9.12] for hospitalizations and OR 3.6 [95% CI 1.59-8.14] and 6.0 [95% CI 1.60-22.69] for ED visits, respectively). ESRD or death occurred among 15% of patients with a CTD. Conclusion.In pediatric patients transferring to an adult rheumatology clinic, continued insurance coverage and referral from a pediatric rheumatologist decreased delays in attending an adult visit; CTD and Black race were associated with high rates of unscheduled health care utilization.

Rheumatische Erkrankungen – Betreuung am Übergang zum Erwachsenenalter

“…Infektionsverhütung für Rheumapatienten (insbesondere jenen unter Methotrexat und Biologika) ist. [18]. Auch andere Untersuchungen zur Kontinuität der Versorgung führen Defizite vor Augen.…”

Health Literacy and Patient Activation in the Pediatric to Adult Transition in Systemic Lupus Erythematosus: Patient and Health Care Team Perspectives

“…Transition to adult care is a particularly tumultuous period, with increases in new renal manifestations (4), progression to end-stage renal disease (ESRD) (5), anxiety and depression (6), and ongoing or new neuropsychiatric symptoms (7). Younger adults (ages [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] and those with ESRD are more likely to have increased 30-day hospitalization rates, reinforcing the concept that transition to adult care is a particularly vulnerable period (8).…”

Longitudinal assessment of preparation for care transition among adolescents and young adults with rheumatologic disease: a single-center pilot study

“…Adolescents and young adults (AYA) are at high risk for poor outcomes and gaps in care when transitioning from pediatric to adult care [ 1 , 2 ]. The risks of this care transition period are well described in AYA with rheumatologic diseases, including increased disease flares, missed follow up visits, medication non-adherence, and even increased mortality [ 3 – 6 ]. There are increasing efforts to bring comprehensive transition care to AYA with rheumatologic diseases [ 7 – 11 ], though many pediatric rheumatology programs lack formalized transition pathways [ 12 , 13 ].…”