Xinbei Zhao1, Lise M Bjerre2, Geoffrey C Nguyen3, David R Mack4, Douglas G Manuel5, Steven Hawken6, Nassim Mojaverian7, Natasha Bollegala8, Eric I Benchimol9. 1. Children's Hospital of Eastern Ontario IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada. 2. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada; Bruyère Research Institute, Ottawa, Canada. 3. Institute for Clinical Evaluative Sciences, Toronto, Canada; Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Canada. 4. Children's Hospital of Eastern Ontario IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Canada. 5. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada. 6. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Ottawa Hospital Research Institute, Ottawa, Canada. 7. Institute for Clinical Evaluative Sciences, Toronto, Canada. 8. Women's College Hospital, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada. 9. Children's Hospital of Eastern Ontario IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Canada. Electronic address: ebenchimol@cheo.on.ca.
Abstract
OBJECTIVES: To evaluate the impact of the transfer from pediatric to adult care on health services use for adolescents with inflammatory bowel disease (IBD). STUDY DESIGN: A population-based retrospective cohort study identified all children diagnosed with IBD from 1994 to 2008 and treated by pediatric gastroenterologists in Ontario, Canada, using health administrative data. Self-controlled case series analyses compared health service use in the 2 years before and 2 years after transfer with adult gastroenterologists, with a 6-month washout period at transfer. Outcomes evaluated included IBD-specific and IBD-related hospitalizations, emergency department use, outpatient visits, and laboratory use. The relative incidence (RI) in the post-transfer period was compared with pretransfer periods using Poisson regression analysis controlling for transfer starting age. Analyses were stratified by IBD type: Crohn's disease (CD) and ulcerative colitis (UC). RESULTS: There were 536 patients included in the study (388 CD, 148 UC). Emergency department use rate was higher after transfer for both CD (RI, 2.12; 95% CI, 1.53-2.93) and UC (RI, 2.34; 95% CI, 1.09-5.03), as were outpatient visits (CD: RI, 1.56; 95% CI, 1.42-1.72; UC: RI, 1.48; 95% CI, 1.24-1.76), and laboratory investigations (CD: RI, 1.43; 95% CI, 1.26-1.63; UC: 1.38; 95% CI, 1.13-1.68). There was no change in the hospitalization rate (CD: RI, 0.70; 95% CI, 0.42-1.18; UC: RI, 2.41; 95% CI, 0.62-9.40). CONCLUSIONS: Health services use in Canada increases after transfer from pediatric to adult care for outpatient visits, emergency department use, and laboratory tests, but not hospitalizations. This study has implications for the planning and budgeting of care for adolescents transitioning to adult care.
OBJECTIVES: To evaluate the impact of the transfer from pediatric to adult care on health services use for adolescents with inflammatory bowel disease (IBD). STUDY DESIGN: A population-based retrospective cohort study identified all children diagnosed with IBD from 1994 to 2008 and treated by pediatric gastroenterologists in Ontario, Canada, using health administrative data. Self-controlled case series analyses compared health service use in the 2 years before and 2 years after transfer with adult gastroenterologists, with a 6-month washout period at transfer. Outcomes evaluated included IBD-specific and IBD-related hospitalizations, emergency department use, outpatient visits, and laboratory use. The relative incidence (RI) in the post-transfer period was compared with pretransfer periods using Poisson regression analysis controlling for transfer starting age. Analyses were stratified by IBD type: Crohn's disease (CD) and ulcerative colitis (UC). RESULTS: There were 536 patients included in the study (388 CD, 148 UC). Emergency department use rate was higher after transfer for both CD (RI, 2.12; 95% CI, 1.53-2.93) and UC (RI, 2.34; 95% CI, 1.09-5.03), as were outpatient visits (CD: RI, 1.56; 95% CI, 1.42-1.72; UC: RI, 1.48; 95% CI, 1.24-1.76), and laboratory investigations (CD: RI, 1.43; 95% CI, 1.26-1.63; UC: 1.38; 95% CI, 1.13-1.68). There was no change in the hospitalization rate (CD: RI, 0.70; 95% CI, 0.42-1.18; UC: RI, 2.41; 95% CI, 0.62-9.40). CONCLUSIONS: Health services use in Canada increases after transfer from pediatric to adult care for outpatient visits, emergency department use, and laboratory tests, but not hospitalizations. This study has implications for the planning and budgeting of care for adolescents transitioning to adult care.
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