1 Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts.
2 Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Ann Am Thorac Soc. 2018 Feb;15(2):234-240. doi: 10.1513/AnnalsATS.201705-357OC.
With improved survival into adulthood, the number of dedicated adult cystic fibrosis (CF) care programs has expanded in the United States over the past decade. Transfer from pediatric to adult CF programs represents a potential time for lapses in recommended health care.
To describe variability in transfer between pediatric and adult CF care programs and to identify factors associated with prolonged gaps in care.
Using the U.S. CF Foundation Patient Registry, we identified individuals with CF who transferred care from a pediatric to an adult CF care program during 2007 to 2013. A gap in care was defined as the time in days between the last recorded pediatric encounter and the first recorded adult encounter. A hierarchical multivariable regression model was applied to investigate the effect of program- and patient-level factors on gaps in care.
There were 1,946 individuals at 155 pediatric CF programs who transferred to an adult CF program during the analytic period. The mean age at transfer was 21.1 years, with 68% transferring care between ages 18 and 21 years. The mean gap in care during transfer was 183 days (median, 106 d; range, 2-1,843 d); 47% had a less than 100-day gap, and 13% had a greater than or equal to 365-day gap (prolonged gap). Prolonged gaps in care were more likely to occur among those younger than age 18 years (odds ratio, 3.33; 95% confidence interval, 2.06-5.37) at the time of transfer and those who transferred to an adult program that was in a different city from their pediatric or affiliate program (odds ratio, 2.16; 95% confidence interval, 1.48-3.17). Having any health insurance coverage was associated with decreased likelihood of prolonged gaps (private insurance vs. no insurance [odds ratio, 0.15; 95% confidence interval, 0.09-0.23] or any government insurance versus no insurance [odds ratio, 0.11; 95% confidence interval, 0.07-0.18]). Lung function, nutritional status, and receipt of intravenous antibiotics in the final year of pediatric care were not associated with the length of gap in care during transfer.
In the United States, the majority of individuals transferring from pediatric to adult CF care do so between ages 18 and 21 years. A minority had a gap greater than or equal to 365 days during transfer to adult care, suggesting that most did not have a disruption in recommended quarterly care visits during the transfer period. Risk factors for prolonged gaps in care include younger age at transfer, lack of health insurance, and relocation. Care coordination during transition in CF may minimize lapses in care by identifying and more closely addressing the needs of individuals at highest risk.
随着成年后生存率的提高，美国专门的成人囊性纤维化（CF）护理项目数量在过去十年中有所增加。从儿科到成人 CF 项目的转移代表了推荐的医疗保健可能出现中断的潜在时期。
描述儿科和成人 CF 护理项目之间转移的可变性，并确定与护理时间延长相关的因素。
使用美国 CF 基金会患者登记处，我们确定了在 2007 年至 2013 年间从儿科 CF 护理项目转移到成人 CF 护理项目的 CF 患者。护理中断定义为最后一次记录的儿科就诊和第一次记录的成人就诊之间的天数。应用分层多变量回归模型研究项目和患者水平因素对护理中断的影响。
在分析期间，有 1946 人在 155 个儿科 CF 项目中转移到成人 CF 项目。转移时的平均年龄为 21.1 岁，68%的人在 18 至 21 岁之间转移护理。转移期间护理中断的平均时间为 183 天（中位数为 106 天；范围为 2-1843 天）；47%的人中断时间少于 100 天，13%的人中断时间大于或等于 365 天（延长中断）。在转移时年龄小于 18 岁（比值比，3.33；95%置信区间，2.06-5.37）和转移到与儿科或附属项目所在城市不同的成人项目的患者中，更有可能出现延长的护理中断（比值比，2.16；95%置信区间，1.48-3.17）。任何形式的医疗保险都与延长护理中断的可能性降低相关（私人保险与无保险[比值比，0.15；95%置信区间，0.09-0.23]或任何政府保险与无保险[比值比，0.11；95%置信区间，0.07-0.18]）。在儿科护理的最后一年，肺功能、营养状况和静脉使用抗生素与转移期间的护理中断长度无关。
在美国，大多数从儿科 CF 护理转移到成人 CF 护理的患者在 18 至 21 岁之间转移。少数患者在转移到成人护理期间的中断时间大于或等于 365 天，这表明大多数患者在转移期间没有中断推荐的每季度就诊。延长护理中断的风险因素包括转移时年龄较小、缺乏医疗保险和搬迁。CF 过渡期的护理协调可通过识别和更密切地解决高风险人群的需求，最大限度地减少护理中断。
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