Yi Zhong1, Donna B Gilleskie2, Miranda A L van Tilburg3, Stephen R Hooper4, Eniko Rak4, Karina Javalkar5, Meaghan Nazareth6, Brian Pitts7, Maggwa Ndugga8, Nina Jain7, Laura Hart9, Suneet Bhansali10, Jordan Richards4, Randal K Detwiler5, Karin True5, Alexandre S F de Pomposo11, Maria E Ferris7. 1. Department of Economics, University of North Carolina at Chapel Hill (UNC), Chapel Hill. 2. Department of Economics, University of North Carolina at Chapel Hill (UNC), Chapel Hill. Electronic address: dgill@email.unc.edu. 3. Department of Clinical Research, Campbell University, Buies Creek; Department of Medicine, UNC, Chapel Hill, NC; School of Social Work, University of Washington, Seattle, Washington DC. 4. Department of Allied Health Sciences, UNC School of Medicine, Chapel Hill, NC. 5. UNC Kidney Center, Department of Medicine, UNC School of Medicine, Chapel Hill, NC. 6. School of Public Health, Columbia University, New York City, NY. 7. Department of Pediatrics, UNC School of Medicine, Chapel Hill, NC. 8. Undergraduate Studies, UNC School of Medicine, Chapel Hill, NC. 9. Cecil G. Sheps Center for Health Services Research, UNC School of Medicine NRSA Primary Care Research Fellowship (T32-HP14001), Chapel Hill, NC. 10. School of Medicine, UNC, Chapel Hill, NC. 11. School of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico.
Abstract
OBJECTIVE: To evaluate the roles of key individual, family, and illness characteristics on the levels of and gains in longitudinal healthcare transition (HCT) readiness in the pediatric setting and/or self-management skills (SMS) in the adult-focused setting, we used a large dataset with longitudinal measurements from 2006 to 2015. STUDY DESIGN: This longitudinal observational study followed 566 adolescents and young adults with chronic conditions at University of North Carolina Hospitals. TRxANSITION Index measurements, which represent learning outcomes rather than health outcomes, were collected multiple times per patient and analyzed using a novel application of an education-based approach. RESULTS: Levels of and gains in HCT/SMS scores increased with age (P < .001) with smaller increases at older ages. Mastery of skills varied by age with self-management achieved after 20 years of age. Scores varied positively by father's education and negatively by mother's education and duration of diagnosis. Gains in scores further varied positively with private insurance and negatively with mother's education and duration of diagnosis. CONCLUSIONS: We found diminishing positive increases in HCT/SMS scores as patients become older and smaller levels of and gains in readiness among younger patients with more educated mothers. Risk factors for absolute level of HCT/SMS readiness and inadequate longitudinal gains are not always the same, which motivates a deeper understanding of this dynamic process through additional research. This information can guide providers to focus HCT/SMS preparation efforts on skills mastered at particular ages and to identify patients at risk for inadequate development of HCT/SMS skills.
OBJECTIVE: To evaluate the roles of key individual, family, and illness characteristics on the levels of and gains in longitudinal healthcare transition (HCT) readiness in the pediatric setting and/or self-management skills (SMS) in the adult-focused setting, we used a large dataset with longitudinal measurements from 2006 to 2015. STUDY DESIGN: This longitudinal observational study followed 566 adolescents and young adults with chronic conditions at University of North Carolina Hospitals. TRxANSITION Index measurements, which represent learning outcomes rather than health outcomes, were collected multiple times per patient and analyzed using a novel application of an education-based approach. RESULTS: Levels of and gains in HCT/SMS scores increased with age (P < .001) with smaller increases at older ages. Mastery of skills varied by age with self-management achieved after 20 years of age. Scores varied positively by father's education and negatively by mother's education and duration of diagnosis. Gains in scores further varied positively with private insurance and negatively with mother's education and duration of diagnosis. CONCLUSIONS: We found diminishing positive increases in HCT/SMS scores as patients become older and smaller levels of and gains in readiness among younger patients with more educated mothers. Risk factors for absolute level of HCT/SMS readiness and inadequate longitudinal gains are not always the same, which motivates a deeper understanding of this dynamic process through additional research. This information can guide providers to focus HCT/SMS preparation efforts on skills mastered at particular ages and to identify patients at risk for inadequate development of HCT/SMS skills.
Authors: Kathryn Dahir; Ruban Dhaliwal; Jill Simmons; Erik A Imel; Gary S Gottesman; John D Mahan; Gnanagurudasan Prakasam; Allison I Hoch; Prameela Ramesan; Maria Díaz-González de Ferris Journal: J Clin Endocrinol Metab Date: 2022-02-17 Impact factor: 5.958