Division of Pediatric Gastroenterology, Hepatology and Nutrition.
The Center for Innovation in Pediatric Practice, The Research Institute, Nationwide Children's Hospital.
J Pediatr Gastroenterol Nutr. 2021 Apr 1;72(4):563-568. doi: 10.1097/MPG.0000000000003013.
Adolescents and young adults (AYAs) are at risk for disease exacerbations and increased health care utilization around the time of transition to adult care. Our aim was to identify risk factors predictive of a suboptimal transition for AYA with inflammatory bowel disease.
We performed a retrospective chart review of patients with pediatric inflammatory bowel disease transferred to adult care from our institution in 2016 and 2017, recording demographic, psychosocial, and disease-specific data. Post-transfer data were obtained via the health care information exchange from the adult provider within our electronic medical record. We defined suboptimal transition as either a return to pediatric care or requiring care escalation within 1 year of transfer.
Out of 104 subjects 37 (36%) were found to have had a suboptimal transition. Our models suggest that a suboptimal transition is associated with several risk factors including any mental health diagnosis (odds ratio [OR] = 4.15; 95% confidence interval [95% CI]: 1.18-14.59), history of medication nonadherence (OR = 5.15 [95% CI: 1.52-17.42]), public insurance (OR = 6.60 [95% CI: 1.25-34.96]), higher Physician Global Assessment score at time of transition (OR = 6.64 [95% CI: 1.60-27.58], and short Pediatric Crohn Disease Activity Index scores (OR = 1.17 [95% CI: 1.03-1.33]). Higher hemoglobin levels at transition were protective (OR = 0.69 [95% CI: 0.48-0.98]). Age at time of transition, disease duration, and medication type at transition were not found to be associated with transition outcomes.
AYA with public insurance, a mental health history, medication nonadherence, and evidence of active disease may be at greater risk for suboptimal and poor health outcomes at transition.
青少年和年轻人（AYAs）在过渡到成人护理时，面临疾病恶化和增加医疗保健利用的风险。我们的目的是确定预测炎症性肠病 AYA 过渡结果不理想的风险因素。
我们对 2016 年和 2017 年从我们机构转至成人护理的患有儿科炎症性肠病的患者进行了回顾性图表审查，记录了人口统计学、社会心理和疾病特异性数据。通过我们电子病历中的成人提供者从医疗保健信息交换中获取转移后的数据。我们将不理想的过渡定义为在转移后 1 年内返回儿科护理或需要护理升级。
在 104 名患者中，有 37 名（36%）发现过渡结果不理想。我们的模型表明，不理想的过渡与多种风险因素相关，包括任何心理健康诊断（优势比 [OR] = 4.15；95%置信区间 [95%CI]：1.18-14.59）、药物不依从史（OR = 5.15 [95%CI]：1.52-17.42）、公共保险（OR = 6.60 [95%CI]：1.25-34.96）、过渡时的医生整体评估评分较高（OR = 6.64 [95%CI]：1.60-27.58），以及较短的儿科克罗恩病活动指数评分（OR = 1.17 [95%CI]：1.03-1.33）。过渡时较高的血红蛋白水平具有保护作用（OR = 0.69 [95%CI]：0.48-0.98）。过渡时的年龄、疾病持续时间和过渡时的药物类型与过渡结果无关。
患有公共保险、心理健康史、药物不依从和活跃疾病证据的 AYA 可能面临更大的不理想和健康状况不佳的风险。
