Elsevier

The Journal of Pediatrics

Volume 203, December 2018, Pages 280-287.e4
The Journal of Pediatrics

Original Articles
Health Services Use during Transition from Pediatric to Adult Care for Inflammatory Bowel Disease: A Population-Based Study Using Health Administrative Data

https://doi.org/10.1016/j.jpeds.2018.08.021Get rights and content

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.

Section snippets

Methods

This study was approved by the Research Ethics Boards of the Children's Hospital of Eastern Ontario and The Ottawa Hospital. We conducted a retrospective cohort study using health administrative data of all patients in Ontario, Canada, with pediatric-onset IBD who were treated initially by a pediatric gastroenterologist and transferred to an adult gastroenterologist. Ontario administrative data contain all residents of the province diagnosed with IBD during the study period of fiscal years 1994

Descriptive Characteristics

The OCCC contained 4314 children <18 years of age diagnosed with IBD in Ontario from fiscal years 1994 to 2008, of which 536 qualified for the study with sufficient pretransfer and post-transfer follow-up time by both pediatric and adult gastroenterologists (Figure 2). Of these, 1969 patients had ≥1 visit to both pediatric and adult gastroenterologists and 1357 patients had ≥2 visits to both adult and pediatric gastroenterologists. Of these, 602 patients were diagnosed with either CD or UC and

Discussion

Using a population-based cohort of patients with pediatric-onset IBD, we demonstrated increased healthcare use rates after transfer from pediatric to adult gastroenterology care. This increase was found for outpatient visits, laboratory investigations, and ED visits, but not hospitalizations. These findings have important implications for health system planning, because they suggest that undesirable health services use (such as ED use for nonurgent problems) could be prevented with adequate

Data Statement

Parts of this material is based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors, and not necessarily those of CIHI. The dataset from this study is held securely in coded form at The Institute for Clinical Evaluative Sciences. Although data sharing agreements prohibit The Institute for Clinical Evaluative Sciences from making the dataset

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    Funding and Disclosures available at www.jpeds.com.

    Portions of this study were presented as a poster at the Canadian Association of Health Services and Policy Research Annual Meeting, May 28, 2015, Montreal, Quebec, Canada, and as a poster at the World Congress of Pediatric Gastroenterology, Hepatology and Nutrition, October 5-8, 2016, Montreal, Quebec, Canada.

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