Session Title: ARHP Pediatrics
Session Type: Abstract Submissions (ARHP)
Background/Purpose: It is well documented that children with rheumatologic conditions are living into adulthood and require transition of care into the adult medical center. This process is frequently met with a number of barriers that require programs and processes to address the issues for successful transfer of care. Children’s Hospital Los Angeles (CHLA) and the Los Angeles County+University of Southern California Medical Center (LAC+USC MC) decided to collaborate to meet this need. The objective of this study is to evaluate the transfer success rate and length of time from last pediatric appointment to the adult setting. In addition, whether the adherence rates prior to transition correlated with the attendnce rate in the adult setting and identify trends between diagnosis and compliance history while at CHLA.
Methods: Retrospective review of charts from patients scheduled to transfer care from 2008-2013 were reviewed. Patients identified were either without medical coverage or with state-funded Medi-Cal, as these patients require transfer of care to the LAC+USC MC. Demographic data, diagnosis, adherence to pediatric appointments and adherence to adult appointments were noted.
Results: 131 patients were to transfer care from CHLA to USC+LAC MC from fall 2008-spring 2013. There were 103 women, 28 men. Diagnosis included SLE (58), JIA (36), AS (10), MCTD (6), Dermatomyositis (4), Scleroderma (4), Psoriatic arthritis (3), Vasculitis (5), FMF and Sjogrens (1 each) and other (3). Fifty-nine patients (45%) were never seen at LAC+USC MC, while 72 (55%) attended their provided appointment. The mean time from the last CHLA appointment to the first LAC+USC MC appointment was 179.7 days (range: -12 to 1614 days). Adherence with pediatric appointments within the last year of treatment was defined as good (no missed appointments), fair (1-2 missed appointments), or poor (3+ missed appointments). Thirty-two (41.6%) of the 77 patients with good adherence to pediatric appointments were not seen at LAC+USC MC, 26 (55.3%) of 47 patients with fair adherence, and 1 (14.3%) patient of 6 patients with poor adherence. Mean time from last CHLA appointment to first LAC+USC MC appointment for those with good, fair or poor adherence was 97.2 days, 289.5 days, 359.8 days, respectively. Seventeen (47.2%) of 36 patients with JIA did not transfer care to LAC+USC MC, 25 (43.1%) of 58 patients with SLE. The mean time from last CHLA appointment to first LAC+USC MC appointment for those with JIA and SLE were 206.2 days and 217.4 days, respectively.
Conclusion: There are many obstacles to a successful transition from the pediatric to the adult rheumatologist. This data shows, despite having an identified appointment, only 55% of patients successfully transferred care. In addition, of those who demonstrated poor appointment compliance at CHLA, most attended their LAC+USC MC. From our data, it is clear there is work to be done as only half of those requiring transfer of care to LAC+USC MC are seen and many of those after a substantial gap in their care. A large-scale, prospective study of patients during this time period could further elucidate the reasons for these observations and identify areas for improvment.
E. C. Ortiz,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/transition-from-the-pediatric-rheumatologist-to-the-adult-rheumatologist-outcomes-of-5-years-of-experience-between-two-institutions/