Kollengode Madhukar S, Daniels Curt J, Zaidi Ali N
1Department of Internal Medicine and Pediatrics,The Ohio State University Wexner Medical Center,Columbus, OH,USA.
2The Heart Center, Nationwide Children's Hospital,Division of Cardiovascular Medicine,The Ohio State University Wexner Medical Center,Columbus,OH,USA.
Cardiol Young. 2018 Aug;28(8):1001-1008. doi: 10.1017/S1047951118000690. Epub 2018 Jul 3.
Lapses in care during transition in adult CHD patients lead to increased morbidity and mortality. Previous studies have investigated predictors of poor follow-up in universal healthcare paradigms and select American populations. We studied patients with a wide spectrum of CHD severity within a single American centre to identify factors associated with successful internal transition and maintenance of care. Loss of follow-up was defined as no documented cardiac follow-up for ⩾3 years. Ambulatory cardiology patients aged 16-17 years with CHD were retrospectively enrolled and contacted. A survey assessing demographics, patients' understanding of their CHD, medical status, and barriers to care was administered. On the basis of chart review of 197 enrolled patients, 74 demonstrated loss of follow-up (37.6%). Of 78 successfully contacted patients, 58 were surveyed, of whom a minority had loss of follow-up (n=16). The status of most patients with loss of follow-up was not known. Maintenance of care was associated with greater complexity of CHD (p<0.01), establishment of care with an adult CHD provider (p<0.001), use of prescription medications (p<0.001), and receipt of education emphasising the importance of long-term cardiac care (p<0.003). Insurance lapses were not associated with loss of follow-up (p=0.08). Transition and maintenance of care was suboptimal even within a single centre. Over one-third of patients did not maintain care. Patients with greater-complexity CHD, need for medications, receipt of transition education, and care provided by adult CHD providers had superior follow-up.
成人先天性心脏病（CHD）患者在转诊过程中的护理失误会导致发病率和死亡率上升。以往的研究调查了全民医疗模式和部分美国人群中随访不佳的预测因素。我们在一家美国中心研究了患有各种严重程度CHD的患者，以确定与成功的内部转诊和持续护理相关的因素。失访定义为⩾3年无心脏随访记录。对年龄在16 - 17岁的门诊CHD患者进行回顾性纳入并联系。进行了一项调查，评估人口统计学、患者对其CHD的了解、医疗状况以及护理障碍。基于对197名纳入患者的病历审查，74名患者出现失访（37.6%）。在78名成功联系的患者中，58名接受了调查，其中少数患者失访（n = 16）。大多数失访患者的情况不明。持续护理与CHD病情更复杂（p<0.01）、与成人CHD医疗服务提供者建立护理关系（p<0.001）、使用处方药（p<0.001）以及接受强调长期心脏护理重要性的教育（p<0.003）相关。保险中断与失访无关（p = 0.08）。即使在单一中心内，转诊和持续护理情况也不理想。超过三分之一的患者未持续接受护理。CHD病情更复杂、需要用药、接受转诊教育以及由成人CHD医疗服务提供者提供护理的患者随访情况更好。
