Endocr Pract. 2020 May;26(5):508-513. doi: 10.4158/EP-2019-0470. Epub 2020 Feb 11.
Every year, 500,000 youths in the U.S. with chronic disease turn 18 years of age and eventually require transfer to adult subspecialty care. Evidence-based interventions on the organization of transfer of care are limited, although engagement and retention in adult clinic are considered appropriate outcomes. Sustained continuity of care improves patient satisfaction and reduces hospitalization. We conducted a prospective, nonrandomized cohort study of patients with pediatric endocrine conditions, age 16 to 26 years, enrolled upon referral to the adult endocrine clinic of a physician trained in both adult and pediatric endocrinology (Med+Peds endocrinologist). Patients differed based on whether their referral originated from another pediatric endocrinologist (traditional transfer) or if the Med+Peds endocrinologist previously saw the patient in his pediatric endocrine clinic (guided transfer). Rather than relying on arbitrary age criteria, guided transfer to adult clinic occurred when physician and patient considered it appropriate. The primary outcome was show rate at the first and second adult visits. Of 36 patients, 21 were referred by another pediatric endocrinologist and 15 underwent guided transfer. For traditional transfer, show rate to the first and second visit was 38%, compared to 100% in the guided transfer group ( = .0001). Subgroup analysis of 27 patients with diabetes revealed that both groups had similar initial hemoglobin A1c ( = .38), and the guided transfer group maintained hemoglobin A1c. Most traditional transfers were unsuccessful. Guided transfer was significantly more effective, with every patient successfully transferring, and could be implemented with adult endocrinologists willing to see patients in the pediatric clinic. = diabetic ketoacidosis; = hemoglobin A1c; = Internal Medicine and Pediatrics.
每年，美国有 50 万患有慢性疾病的年轻人年满 18 岁，最终需要转至成人专科护理。虽然参与和保留在成人诊所被认为是适当的结果，但关于护理转接组织的循证干预措施有限。持续的连续性护理可提高患者满意度并降低住院率。我们对 16 至 26 岁患有儿科内分泌疾病的患者进行了一项前瞻性、非随机队列研究，这些患者在转诊到接受过成人和儿科内分泌学培训的医师的成人内分泌诊所时入组（医学+儿科内分泌学家）。根据他们的转诊来源，患者分为来自另一位儿科内分泌学家（传统转诊）或医学+儿科内分泌学家之前在他的儿科内分泌诊所看过患者（引导转诊）。引导转诊至成人诊所并非依赖于任意的年龄标准，而是由医生和患者认为合适时进行。主要结局是在第一次和第二次成人就诊时的就诊率。在 36 名患者中，有 21 名由另一位儿科内分泌学家转诊，有 15 名患者接受了引导转诊。对于传统转诊，第一次和第二次就诊的就诊率为 38%，而引导转诊组为 100%（ =.0001）。对 27 名糖尿病患者的亚组分析显示，两组患者的初始血红蛋白 A1c 相似（ =.38），且引导转诊组维持血红蛋白 A1c。大多数传统转诊均不成功。引导转诊明显更有效，所有患者均成功转诊，并且愿意在儿科诊所看到患者的成人内分泌学家可以实施这种转诊。 = 糖尿病酮症酸中毒； = 血红蛋白 A1c； = 内科和儿科学。
