Cohen Eyal, Gandhi Sima, Toulany Alene, Moore Charlotte, Fu Longdi, Orkin Julia, Levy Deborah, Stephenson Anne L, Guttmann Astrid
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;
Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;
Pediatrics. 2016 Mar;137(3):e20152734. doi: 10.1542/peds.2015-2734. Epub 2016 Feb 23.
To compare health care use and costs for youth with chronic health conditions before and after transfer from pediatric to adult health care services.
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.
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.
Pediatric transfer to adult care is characterized by relatively stable short-term patterns of health service use and costs among youth with chronic conditions.
比较患有慢性健康状况的青少年从儿科医疗服务转至成人医疗服务前后的医疗保健利用情况及费用。
将1989年4月1日至1993年4月1日在加拿大安大略省出生的青少年分为11个相互排斥、分层排列的临床分组，包括“复杂”慢性病（CCC）、非复杂慢性病（N-CCC）和慢性心理健康状况（CMHC）。比较儿科服务转移前后（即受试者18岁生日）两个两年期的结果。
在104,497名青少年中，CCC患者的死亡率最高，但转移后并未增加（1.3%对1.5%，P = 0.55）。CCC患者的费用最高，转移后有所下降（转移前后中位数[四分位间距]：4626美元[1253 - 21,435美元]对3733美元[950 - 16,841美元]，P < 0.001）；N-CCC患者的费用略有增加（569美元[263 - 1246美元]对589美元[262 - 1333美元]，P < 0.001），CMHC患者的费用下降（1774美元[659 - 5977美元]对1545美元[529 - 5128美元]，P < 0.001）。仅N-CCC患者的急诊科就诊次数增加（P < 0.001）。高急症急诊科就诊次数在CCC患者（P = 0.04）和N-CCC患者中增加（P < 0.001），但CMHC患者未增加（P = 0.59），CMHC患者的就诊率最高。在11种个体疾病中，仅哮喘患者的费用增加（P < 0.001），而患有神经功能障碍、狼疮、炎症性肠病和情绪/情感障碍的患者费用下降（P < 0.05）。
从儿科转至成人护理的过程中，患有慢性疾病的青少年的医疗服务利用和费用的短期模式相对稳定。
