The transfer from pediatric to adult care for young adults is a vulnerable period. Our objectives were to quantify the time between final pediatric and first adult visit and evaluate unscheduled utilization in care and progression to end‐stage renal disease (ESRD) or death.
We conducted a retrospective analysis of pediatric patients transferring to a large adult rheumatology clinic (ARC). Outcomes included time to first completed adult visit, unscheduled healthcare utilization (hospitalizations and emergency department (ED) visits), and ESRD progression and death progression. Multivariable regression models assessed variables predictive of outcomes of interest.
One hundred forty‐one pediatric patients who transferred care were identified: 77% female, 65% Hispanic, 60% with connective tissue diseases (CTD). The mean time between the final pediatric and first completed adult rheumatology visit was 221 days (range 0 to 1207). In regression modeling, continued insurance coverage, younger age at referral, and referral from a pediatric rheumatologist was predictive of shorter time to completed adult visit (p<0.005). Factors associated with hospitalizations and ED visits included CTD diagnosis and Black race (OR 8.54; 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 CTD.
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 unscheduled rates of healthcare utilization.
Ref: https://onlinelibrary.wiley.com/doi/10.1002/acr.24409
