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Pediatrics. 2016 Mar;137(3):e20152734. doi: 10.1542/peds.2015-2734. Epub 2016 Feb 23.

Health Care Use During Transfer to Adult Care Among Youth With Chronic Conditions.

Author information

1
Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Commonwealth Fund/CFHI Harkness Fellow in Health Care Policy and Practice, New York, New York; eyal.cohen@sickkids.ca.
2
Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;
3
Department of Pediatrics, and Adolescent Medicine, and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;
4
Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and.
5
Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and Centre for Research on Inner City Health, Li Ka Shing, Keenan Research Center, and.
6
Department of Pediatrics, and Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada;
7
Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
8
Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;

Abstract

OBJECTIVE:

To compare health care use and costs for youth with chronic health conditions before and after transfer from pediatric to adult health care services.

METHODS:

Youth born in Ontario, Canada, between April 1, 1989, and April 1, 1993, were assigned to 11 mutually exclusive, hierarchically arranged clinical groupings, including "complex" chronic conditions (CCCs), non-complex chronic conditions (N-CCCs), and chronic mental health conditions (CMHCs). Outcomes were compared between 2-year periods before and after transfer of pediatric services, the subjects' 18th birthday.

RESULTS:

Among 104,497 youth, mortality was highest in those with CCCs, but did not increase after transfer (1.3% vs 1.5%, P = .55). Costs were highest among youth with CCCs and decreased after transfer (before and after median [interquartile range]: $4626 [1253-21,435] vs $3733 [950-16,841], P < .001);Costs increased slightly for N-CCCs ($569 [263-1246] vs $589 [262-1333], P < .001), and decreased for CMHCs ($1774 [659-5977] vs $1545 [529-5128], P < .001). Emergency department visits increased only among youth with N-CCCs (P < .001). High-acuity emergency department visits increased CCCs (P = .04) and N-CCCs (P < .001), but not for CMHC (P = .59), who had the highest visit rate. Among the 11 individual conditions, costs only increased in youth with asthma (P < .001), and decreased (P < .05) in those with neurologic impairment, lupus, inflammatory bowel disease, and mood/affective disorders.

CONCLUSIONS:

Pediatric transfer to adult care is characterized by relatively stable short-term patterns of health service use and costs among youth with chronic conditions.

PMID:
26933203
DOI:
10.1542/peds.2015-2734
[Indexed for MEDLINE]
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