J.C. Chang, MD, MSCE, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA;
A.M. Knight, MD, MSCE, Division of Rheumatology, and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
J Rheumatol. 2021 Jan 1;48(1):105-113. doi: 10.3899/jrheum.191029. Epub 2020 Feb 1.
Youth with systemic lupus erythematosus (SLE) transferring from pediatric to adult care are at risk for poor outcomes. We describe patterns of rheumatology/nephrology care and changes in healthcare use and medication adherence during transfer.
We identified youth ages 15-25 with SLE using US private insurance claims from Optum's deidentified Clinformatics Data Mart. Rheumatology/nephrology visit patterns were categorized as (1) unilateral transfers to adult care within 12 months, (2) overlapping pediatric and adult visits, (3) lost to followup, or (4) continuing pediatric care. We used negative binomial regression and paired t tests to estimate changes in healthcare use and medication possession ratios (MPR) after the last pediatric (index) visit. We compared MPR between youth who transferred and age-matched peers continuing pediatric care.
Of the 184 youth transferred out of pediatric care, 41.8% transferred unilaterally, 31.5% had overlapping visits over a median of 12 months before final transfer, and 26.6% were lost to followup. We matched 107 youth continuing pediatric care. Overall, ambulatory care use decreased among those lost to followup. Acute care use decreased across all groups. MPR after the index date were lower in youth lost to followup (mean 0.24) compared to peers in pediatric care (mean 0.57, p < 0.001).
Youth with SLE with continuous private insurance coverage do not use more acute care after transfer to adult care. However, a substantial proportion fail to see adult subspecialists within 12 months and have worse medication adherence, placing them at higher risk for adverse outcomes.
从儿科转到成人护理的系统性红斑狼疮（SLE）青少年患者存在预后不良的风险。我们描述了风湿科/肾病科的就诊模式，以及在转移过程中医疗服务使用和药物依从性的变化。
我们使用 Optum 去识别的 Clinformatics Data Mart 中的美国私人保险索赔数据，确定了年龄在 15-25 岁的患有 SLE 的青少年。风湿科/肾病科就诊模式分为：（1）在 12 个月内单侧转至成人护理，（2）儿科和成人就诊重叠，（3）失访，或（4）继续儿科护理。我们使用负二项回归和配对 t 检验来估计最后一次儿科（索引）就诊后医疗服务使用和药物持有率（MPR）的变化。我们比较了转至成人护理和匹配的继续儿科护理的同龄青少年的 MPR。
在从儿科护理中转出的 184 名青少年中，41.8%的患者单侧转至成人护理，31.5%的患者在最终转至成人护理前重叠就诊 12 个月中位数，26.6%的患者失访。我们匹配了 107 名继续儿科护理的青少年。总的来说，失访者的门诊护理使用减少。所有组的急性护理使用均减少。与继续儿科护理的同龄人相比，失访者在索引日期后的 MPR 较低（平均 0.24 比 0.57，p < 0.001）。
在转到成人护理后，连续有私人保险覆盖的 SLE 青少年并未更多地使用急性护理。然而，相当一部分患者未能在 12 个月内见到成人专科医生，且药物依从性更差，这使他们面临更高的不良结局风险。
