Background/Purpose:

The transition from pediatric to adult care for young adults with chronic illness is a vulnerable period especially among socioeconomically disadvantaged populations. As part of a quality improvement project, we sought to characterize patterns of healthcare utilization, namely hospitalizations and emergency department (ED) visits during the transfer period between pediatric and adult rheumatologic care in a large public safety net healthcare system.

Methods:

Using an electronic medical record, 95 patients were identified as being between 17 and 21 years of age at the time of referral to adult rheumatology between 3/2014 and 4/2017. Following chart review, 65 of these patients were confirmed as transitioning between pediatric and adult care. Data on disease categories, demographics, medical coverage, and referring provider were extracted and comparisons made regarding hospitalizations and ED visits (excluding visits which were clearly unrelated to an underlying rheumatic disease) by using unpaired t-test and one-way analysis of variance.

Results:

Among the 65 patients transitioning to adult care, 72% were female, 74% were Hispanic, 49% had a connective tissue disease (CTD), 49% had juvenile idiopathic arthritis (JIA), 75% had Medicaid, and 74% were referred by a pediatric rheumatologist (Table 1).  Hospitalizations and ED visits were common (20% and 28% of patients, respectively) during the transfer period, and were more common among those with a CTD (compared to JIA), and in blacks (compared with Hispanics and whites) (Figure 1).  Those with a lapse in medical coverage during the transfer period and lack of coverage at the time of initial referral had significantly higher healthcare utilization than those with consistent medical coverage.  Those referred to adult care by a pediatric rheumatologist had significantly fewer hospitalizations and ED visits than those referred by other clinicians (Figure 2).

Conclusion:

Hospitalizations and ED visits are especially prevalent among patients transitioning from pediatric to adult rheumatologic care.  Factors associated with high utilization included having a CTD, black race, lapse in medical coverage during the transfer period, lack of coverage at initial referral to adult care, and being referred by someone other than a pediatric rheumatologist.