Playfair Matthew, McClure James Andrew, Le Britney, Cassidy Caitlin, Wang Peter, Welk Blayne, Dave Sumit
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
ICES Western, London, Ontario, Canada.
Paediatr Child Health. 2023 Jul 5;29(5):280-285. doi: 10.1093/pch/pxad048. eCollection 2024 Aug.
Transition from multidisciplinary paediatric to adult care results in a significant change in the intensity of care provided to patients with spina bifida (SB).
To compare planned and unplanned health care utilization and costs of care of transitioning SB patients.
Through a retrospective population-based cohort study, patients with SB born in Ontario between 1988 and 1999 were studied using routinely collected data analysed at ICES. Patients were followed longitudinally from age 16 to 22 years with comparisons made between the paediatric baseline year (age 16) to the first 3 years of adulthood (ages 19 to 21). A composite primary outcome of unplanned emergency room (ER) visits, hospitalizations and emergency surgical procedures, was compared before and after transition. Secondary outcomes included these variables individually and estimated health care costs.
In the 299 patients, no significant differences were identified in the composite primary outcome between periods (P = 0.09). Unplanned ER visits (P = 0.004) and emergency surgical procedures (P = 0.02) increased after transition. Despite this, the estimated individual total cost of care declined after transition (P = 0.03). Further, multivariable analysis identified rural residence (RR 1.78, confidence interval [CI] 1.30 to 2.44) and previous urologic surgery (RR 1.91, CI 1.41 to 2.57) as significant predictors of increased need for emergent care and health care costs, respectively.
Patients with SB in Ontario have higher rates of ER usage and unplanned surgery after the transition to adult care. While this does not drive an increase in health care costs, improvements in the care of transitioned SB patients, particularly rural patients and those with prior urologic surgery, may decrease the requirement for acute care.
从多学科儿科护理过渡到成人护理，会导致脊柱裂（SB）患者所接受护理的强度发生显著变化。
比较计划内和计划外的医疗保健利用率以及脊柱裂患者过渡护理的费用。
通过一项基于人群的回顾性队列研究，利用在ICES分析的常规收集数据，对1988年至1999年在安大略省出生的脊柱裂患者进行研究。对患者从16岁到22岁进行纵向随访，并比较儿科基线年（16岁）到成年期的前3年（19岁至21岁）的情况。比较了过渡前后计划外急诊室（ER）就诊、住院和急诊外科手术的综合主要结局。次要结局包括这些变量单独的情况以及估计的医疗保健费用。
在299名患者中，各时期之间的综合主要结局未发现显著差异（P = 0.09）。过渡后计划外急诊室就诊（P = 0.004）和急诊外科手术（P = 0.02）有所增加。尽管如此，过渡后估计的个人护理总费用有所下降（P = 0.03）。此外，多变量分析确定农村居住（风险比[RR] 1.78，置信区间[CI] 1.30至2.44）和先前的泌尿外科手术（RR 1.91，CI 1.41至2.57）分别是紧急护理需求增加和医疗保健费用增加的显著预测因素。
安大略省的脊柱裂患者在过渡到成人护理后急诊室使用率和计划外手术率较高。虽然这并未导致医疗保健费用增加，但改善脊柱裂患者过渡护理，特别是农村患者和先前接受过泌尿外科手术的患者的护理，可能会减少急性护理的需求。
