*Division of Gastroenterology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; †Department of Pediatrics, Children's Hospital of Eastern Ontario, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada; ‡Sick Kids, Division of Gastroenterology Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; §Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon; ‖Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada; and ¶Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Inflamm Bowel Dis. 2017 Sep;23(9):1483-1491. doi: 10.1097/MIB.0000000000001200.
Patients diagnosed with inflammatory bowel disease (IBD) during childhood require transfer to an adult gastroenterologist, in Ontario usually just before their 18th birthday. Pediatric onset IBD is a complex phenotype with demonstrated noncompliance risk that may require targeted measures to optimize health care outcomes in the adult care setting.
The purpose of this study was to determine the impact of posttransfer health care setting (academic versus community gastroenterologist) on emergent health resource utilization.
This was a population-based retrospective cohort study using health care administrative data from Ontario, Canada. A cohort of patients with Pediatric onset IBD was identified and health resource utilization during a 2-year pretransfer period, transfer of care period and 2-year posttransfer period was analyzed. Posttransfer health care setting was defined as academic (i.e., gastroenterologists providing care in a university affiliated tertiary care center) versus community. A third comparator group, loss to follow-up, was also identified. The primary outcome of this study comprised emergency department utilization. Secondary outcomes included hospitalizations, surgeries, ambulatory visits, endoscopic investigations, and radiological investigations.
Overall, there were no significant differences found in emergency department use, ambulatory care visits (aside from the expected drop in the lost to follow-up group), hospitalizations, endoscopic procedures, or radiological procedures between exposure groups.
Posttransfer health care setting does not seem to significantly impact emergent health resource utilization in the posttransfer period.
在安大略省，被诊断为炎症性肠病（IBD）的儿童患者通常在 18 岁生日前需要转介给成人胃肠病学家。儿科发病的 IBD 是一种表现出不依从风险的复杂表型，可能需要采取有针对性的措施，以优化成人护理环境中的医疗保健结果。
本研究旨在确定转介后医疗保健环境（学术与社区胃肠病学家）对紧急卫生资源利用的影响。
这是一项基于人群的回顾性队列研究，使用来自加拿大安大略省的医疗保健行政数据。确定了患有儿科发病 IBD 的患者队列，并分析了转介前 2 年、转介期间和转介后 2 年期间的卫生资源利用情况。转介后的医疗保健环境定义为学术（即，在大学附属三级护理中心提供护理的胃肠病学家）与社区。还确定了第三个对照组，即失访。本研究的主要结果包括急诊利用情况。次要结果包括住院、手术、门诊就诊、内镜检查和放射学检查。
总体而言，在急诊利用、门诊就诊（除了失访组的预期下降外）、住院、内镜检查或放射学检查方面，暴露组之间没有发现显著差异。
转介后的医疗保健环境似乎并没有显著影响转介后紧急卫生资源的利用。
