Bohun Claudine M, Woods Patricia, Winter Christiane, Mitchell Julie, McLarry Joel, Weiss Joseph, Broberg Craig S
1Division of Pediatric Cardiology,Oregon Health & Science University,Portland,Oregon,United states of America.
2Adult Congenital Heart Program,Knight Cardiovascular Institute,Oregon Health & Science University,Portland,Oregon,United states of America.
Cardiol Young. 2016 Feb;26(2):327-33. doi: 10.1017/S1047951115000220. Epub 2015 Apr 13.
Transferring patients with CHD from paediatric to adult care has been challenging, especially across institutions. Within a single institution, some issues such as provider interaction, information exchange, or administrative directives should not play a significant role, and should favour successful transfer.
We studied patients who were eligible for transfer to the adult congenital heart disease service within our institution in order to identify factors associated with successful transfer to adult care providers versus failure to transfer.
Patients above18 years of age with CHD who were seen by paediatric cardiologists before January, 2008 were identified through a patient-care database. Records were reviewed to determine follow-up between 2008 and 2011 and to determine whether the patient was seen in the adult congenital cardiology clinic, paediatric cardiology clinic, or had no follow-up, and statistical comparisons were made between groups.
After reviewing 916 records, 229 patients were considered eligible for transition to adult congenital cardiology. Of these, 77 (34%) were transferred successfully to adult congenital cardiology, 47 (21%) continued to be seen by paediatric cardiologists, and 105 (46%) were lost to follow-up. Those who transferred successfully differed with regard to complexity of diagnosis, insurance, and whether a formal referral was made by a paediatric care provider. Only a small fraction of the patients who were lost to follow-up could be contacted.
Within a single institution, with shared information systems, administrations, and care providers, successful transfer from paediatric to adult congenital cardiology was still poor. Efforts for successful retention are just as vital as those for transfer.
将冠心病患儿转至成人护理机构一直具有挑战性，尤其是跨机构转诊。在单一机构内，诸如医护人员互动、信息交流或行政指令等问题不应起重大作用，而应有利于成功转诊。
我们研究了本机构内符合转至成人先天性心脏病服务条件的患者，以确定与成功转至成人护理机构或转诊失败相关的因素。
通过患者护理数据库识别出2008年1月前由儿科心脏病专家诊治的18岁以上冠心病患者。审查记录以确定2008年至2011年期间的随访情况，并确定患者是在成人先天性心脏病诊所、儿科心脏病诊所就诊，还是失访，然后对各组进行统计学比较。
在审查了916份记录后，229名患者被认为符合转至成人先天性心脏病科的条件。其中，77名（34%）成功转至成人先天性心脏病科，47名（21%）继续由儿科心脏病专家诊治，105名（46%）失访。成功转诊的患者在诊断复杂性、保险情况以及儿科护理人员是否进行正式转诊方面存在差异。失访患者中只有一小部分能够联系上。
在单一机构内，尽管有共享信息系统、管理部门和护理人员，但从儿科转至成人先天性心脏病科的成功率仍然很低。成功留住患者的努力与转诊努力同样重要。
