Health Care Use During Transfer to Adult Care Among Youth With Chronic Conditions

Cohen, Eyal; Gandhi, Sima; Toulany, Alene; Moore, Charlotte; Fu, Longdi; Orkin, Julia; Levy, Deborah; Stephenson, Anne L.; Guttmann, Astrid

doi:10.1542/peds.2015-2734

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Article| March 01 2016

Health Care Use During Transfer to Adult Care Among Youth With Chronic Conditions

Eyal Cohen, MD;

Eyal Cohen, MD

aDivisions of Pediatric Medicine and Child Health Evaluative Sciences,

bDepartment of Pediatrics, and

cInstitute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;

dCommonwealth Fund/CFHI Harkness Fellow in Health Care Policy and Practice, New York, New York;

Address correspondence to Eyal Cohen, MD, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada. E-mail: [email protected]

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Sima Gandhi, MSc;

Sima Gandhi, MSc

cInstitute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;

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Alene Toulany, MD;

Alene Toulany, MD

eAdolescent Medicine, and

bDepartment of Pediatrics, and

fInstitute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;

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Charlotte Moore, MD;

Charlotte Moore, MD

aDivisions of Pediatric Medicine and Child Health Evaluative Sciences,

bDepartment of Pediatrics, and

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Longdi Fu, MSc;

Longdi Fu, MSc

cInstitute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;

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Julia Orkin, MD;

Julia Orkin, MD

aDivisions of Pediatric Medicine and Child Health Evaluative Sciences,

bDepartment of Pediatrics, and

gCentre for Research on Inner City Health, Li Ka Shing, Keenan Research Center, and

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Deborah Levy, MD;

Deborah Levy, MD

hRheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada;

bDepartment of Pediatrics, and

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Anne L. Stephenson, MD;

Anne L. Stephenson, MD

fInstitute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;

iDivision of Respirology, Department of Medicine, St Michael’s Hospital, Toronto, Ontario, Canada

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Astrid Guttmann, MDCM

aDivisions of Pediatric Medicine and Child Health Evaluative Sciences,

bDepartment of Pediatrics, and

fInstitute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;

cInstitute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;

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Address correspondence to Eyal Cohen, MD, Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada. E-mail: [email protected]

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Pediatrics (2016) 137 (3): e20152734.

https://doi.org/10.1542/peds.2015-2734

OBJECTIVE:

To compare health care use and costs for youth with chronic health conditions before and after transfer from pediatric to adult health care services.

METHODS:

Youth born in Ontario, Canada, between April 1, 1989, and April 1, 1993, were assigned to 11 mutually exclusive, hierarchically arranged clinical groupings, including “complex” chronic conditions (CCCs), non-complex chronic conditions (N-CCCs), and chronic mental health conditions (CMHCs). Outcomes were compared between 2-year periods before and after transfer of pediatric services, the subjects’ 18th birthday.

RESULTS:

Among 104 497 youth, mortality was highest in those with CCCs, but did not increase after transfer (1.3% vs 1.5%, P = .55). Costs were highest among youth with CCCs and decreased after transfer (before and after median [interquartile range]: $4626 [1253–21 435] vs $3733 [950–16 841], P < .001);Costs increased slightly for N-CCCs ($569 [263–1246] vs $589 [262–1333], P < .001), and decreased for CMHCs ($1774 [659–5977] vs $1545 [529–5128], P < .001). Emergency department visits increased only among youth with N-CCCs (P < .001). High-acuity emergency department visits increased CCCs (P = .04) and N-CCCs (P < .001), but not for CMHC (P = .59), who had the highest visit rate. Among the 11 individual conditions, costs only increased in youth with asthma (P < .001), and decreased (P < .05) in those with neurologic impairment, lupus, inflammatory bowel disease, and mood/affective disorders.

CONCLUSIONS:

Pediatric transfer to adult care is characterized by relatively stable short-term patterns of health service use and costs among youth with chronic conditions.

2016

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Health Care Use During Transfer to Adult Care Among Youth With Chronic Conditions

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