Background/Purpose: Transfer from pediatric- to adult-oriented health care is challenging for patients with childhood-onset rheumatologic disease, and may be associated with treatment non-adherence, disease flares and urgent healthcare utilization. This study aimed to measure transition outcomes among young adults transferring from pediatric to adult care at a single US academic medical center, before and after implementation of transition process improvements.

Methods: Transition process improvements implemented by the pediatric rheumatology practice between 2012 and 2017 included the creation of a transition policy, systematic identification of transition-age patients, and quarterly transition planning rounds. Electronic health record (EHR) query was used to identify patients who transferred from pediatric to adult rheumatology care within the institution during 2012-2017. Primary endpoints were transfer time (time from last pediatric to first adult appointment) and successful transfer. Successful transfer was defined as 1) transfer time from pediatric to adult care <6 months and 2) completion of >2 visits with an adult provider within a 12-month period. Secondary endpoints were pre- and post- transfer disease activity as measured by physician global assessment or SLEDAI score (active v. inactive), and insurance type (public, private, both). We compared outcomes to those of patients who transferred during 1995-2005, prior to the implementation of transition support processes. Bivariate statistics were used to compare differences between groups.   

Results: 87 patients transferred from pediatric to adult rheumatology care during 2012-2017, and 31 patients transferred during 1995-2005 (Table 1). Diagnoses were similar in both groups. During 2012-2017, median transfer time was significantly shorter (3.5 v. 7.1 months, p=0.03), and 52% of patients transitioned successfully. Transitioning patients were more likely to have active disease in 1995-2005, both pre-transfer (61% vs 29%, p=0.001) and post-transfer (61% vs 26%, p=0.001). More patients were publicly insured pre-transfer during 1995-2005 (74% public and 26% private vs. 42% public, 55% private and 2% both, p=0.009), but there were no differences in insurance type post-transfer.

Conclusion: During the implementation of transition initiatives, median transfer time from pediatric to adult rheumatology significantly decreased, and over half of patients transferred successfully. Disease activity at the time of transfer also improved, which may reflect improvements in disease management or differences in disease severity. Although direct causal associations between transition support interventions and transfer success cannot be made, this study suggests that implementation of structured transition processes may positively impact the transfer to adult care.