source: American Journal of Hematology

year: 2018

authors: Vikki G. Nolan, Sheila M. Anderson, Matthew P. Smeltzer, Jerlym S. Porter, Yvonne M. Carroll, Ian M. Brooks, Nada Elmagboul, James G. Gurney, Jane S. Hankins

Survival to adulthood for children with sickle cell disease (SCD) in the United States is above 95%, however morbidity and mortality substantially increase following departure from pediatric care. Acute healthcare utilization (emergency department visits and hospitalization) is highest during pediatric to adult care transition (ages 18–30). Deficits in planning and care coordination as patients move from the pediatric to adult care setting lead to breaks in care continuity and contribute to poor healthcare outcomes.

A critical step in ensuring adequate care continuity during healthcare transition is engagement with the new adult provider. Although different service models of healthcare transition have been tested in other chronic diseases, there is insufficient research in the SCD population. Recognizing the need for better integration between pediatric and adult care, we implemented a co-location model of transition to adult care.

Our co-location model consists of systematic overlap between pediatric and adult care by creating two levels of intersection at both the nursing and physician levels and offers organized disease education (Supporting Information). We hypothesized that among youth with SCD who received co-located pediatric–adult transitional care, acute healthcare utilization rates would not increase after transfer.

Demographics, exposure to hydroxyurea and chronic transfusion therapy, acute care visits, hospitalizations, 30-day readmissions, and health-maintenance visits occurring during pediatric (ages 16–17) and adult (ages 18–19) care were collected. We compared the rate of acute healthcare utilization before and after transfer from pediatric to adult care among youth with SCD who received co-located care, and evaluated the relation between patient knowledge of SCD-related pain with healthcare utilization.

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