Pediatric to Adult Rheumatology Care: Working Toward a Smoother Transition
The median transfer time from pediatric to adult rheumatology care decreased significantly after a pediatric practice implemented changes to its transition process between 2012 and 2017, according to results from a single center study presented at the 2018 ACR/ARHP Annual Meeting.
The transfer from pediatric- to adult-oriented health care can be challenging for patients with childhood-onset rheumatologic disease, and may be associated with treatment non-adherence, disease flares, and other complications.
“Transfer and transition are daunting processes because they require time and resources that are often lacking in today’s medical environment—they demand additional communication and diligence with little incentive or support,” Dr Kimberly DeQuattro told Rheumatology Consultant. “Yet, more individuals with rheumatologic conditions diagnosed in childhood are living into adulthood and a majority will need to transfer/transition to adult providers.”
IF YOU LIKE THIS, READ MORE ACR/ARHP NEWS...
TENS Improves Pain For Women With Fibromyalgia
Gene Confirms Link to Ankylosing Spondylitis
To reach their conclusion, the researchers compared the transfer time—time from last pediatric appointment to first adult appointment— and success of the transfers among patients enrolled at an academic medical center between 1995 and 2005, with a transfer time between 2012 and 2017.
A successful transfer was defined as one that took less than 6 months to complete and the participant visited an adult provider more than 2 times within a 12-month period.
Between 2012 and 2017, the pediatric rheumatology practice also sought to measure the impact of a new transition policy, which included systematically identifying transition-age patients and implementing quarterly transition planning rounds.
During transition improvement implementation, 87 participants transferred from pediatric to adult rheumatology care. Between 2012 and 2017, the median transfer time was 3.5 months, and 52% of patients transitioned successfully compared with a 7.1-month transition time that participants experienced between 1995 and 2005.
“Our data echo other reports in rheumatology with successful transfer rates of 40 to 50%,” DeQuattro said. “It would be ideal if this percentage—in conjunction with effective transition programs—would exceed 80%,” adding that efforts are underway at both national and local levels to overcome barriers to successful transfer and transition.
Disease activity at the time of transfer also improved. The researchers found that participants who transitioned between 1995 and 2005 were more likely to have an active disease than those who transitioned between 2012 and 2017—both pre-transfer (61% vs 29%) and post-transfer (61% vs 26%). DeQuattro attributed this to improvements in pediatric disease management.
“The longitudinal experience at our center suggests that concerted initiatives may be valuable for transfer improvement. Such initiatives must continually be tested and refined,” DeQuattro said. “Many rheumatologists and allied health workers are actively aiming to improve transfer/transition and although there is no ‘one-size-fits-all’ solution, our collective experience across institutions can inform better care for our vulnerable adolescent and young adult patients.”
—Colleen Murphy
Reference:
DeQuattro K, Evans M, Hersh AO, Yazdany J, von Scheven E, Lawson E. A quality update: improved transfer time among rheumatology patients transferring from pediatric to adult care at an academic medical center. Paper presented at: 2018 ACR/ARHP Annual Meeting; October 19-24, 2018; Chicago, IL. https://acrabstracts.org/abstract/a-quality-update-improved-transfer-time-among-rheumatology-patients-transferring-from-pediatric-to-adult-care-at-an-academic-medical-center/. Accessed October 24, 2018.