Eyal Cohen1, Sima Gandhi2, Alene Toulany3, Charlotte Moore4, Longdi Fu2, Julia Orkin5, Deborah Levy6, Anne L Stephenson7, Astrid Guttmann8. 1. Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Commonwealth Fund/CFHI Harkness Fellow in Health Care Policy and Practice, New York, New York; eyal.cohen@sickkids.ca. 2. Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; 3. Department of Pediatrics, and Adolescent Medicine, and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; 4. Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and. 5. Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and Centre for Research on Inner City Health, Li Ka Shing, Keenan Research Center, and. 6. Department of Pediatrics, and Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada; 7. Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada. 8. Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;
Abstract
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.
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.
Authors: Kyleigh Schraeder; Alberto Nettel-Aguirre; Andrew S Mackie; Kerry McBrien; Olesya Barrett; Gina Dimitropoulos; Susan Samuel Journal: Can Fam Physician Date: 2022-05 Impact factor: 3.025
Authors: Antoine Rachas; Philippe Tuppin; Laurence Meyer; Bruno Falissard; Albert Faye; Nizar Mahlaoui; Elise de La Rochebrochard; Marie Frank; Pierre Durieux; Josiane Warszawski Journal: PLoS One Date: 2018-03-13 Impact factor: 3.240