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Skogby S, Goossens E, Johansson B, Moons P, Bratt EL. Which factors affect post-transfer gaps in follow-up care? A qualitative study of the insights of healthcare providers in Sweden and Belgium. BMJ Open 2024; 14:e079996. [PMID: 39153785 PMCID: PMC11331846 DOI: 10.1136/bmjopen-2023-079996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 07/24/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Young people with congenital heart disease (CHD) are frequently affected by discontinued follow-up when transferring from paediatric to adult care. Identified predictors for discontinuation include mostly patient-related factors, and further knowledge of hospital and healthcare system factors is needed. AIM This study aims to explore patient-related, hospital-related and healthcare system-related factors affecting continued follow-up care after transfer, as perceived and experienced by paediatric cardiology and adult CHD (ACHD) healthcare providers (HCPs) in Sweden and Belgium. METHODS This descriptive qualitative study included individual interviews with cardiologists, nurses and administrative staff, subjected to qualitative content analysis. A total of 30 HCPs from 13 specialist care outpatient clinics at 8 different centres in Sweden and Belgium were interviewed. HCPs were included if they had direct contact with patients and had at least 1 year of work experience. FINDINGS The findings illuminate three main categories of factors perceived by HCPs to affect continued follow-up care after transfer, including 'care structure', 'care processes' and 'patient characteristics and circumstances'. Success was described as multifactorial, emphasising processes and structures of care, with a focus on collaboration, organisation, joint responsibility, resources, care relationships and transitional care interventions. Few differences appeared between paediatric and ACHD HCPs and between Swedish and Belgian HCPs. CONCLUSION HCPs perceived factors on patient, hospital and healthcare system levels to influence continued follow-up. Process-related and structure-related aspects of care were perceived as more influential than individual patient characteristics. Hence, future research on discontinued follow-up care should focus on process-related and structure-related aspects of care delivery.
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Affiliation(s)
- Sandra Skogby
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Region Västra Götaland, Children’s Heart Center, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Center for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, Department of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
| | - Bengt Johansson
- Department of Surgical and Perioperative Sciences, Umeå Universitet, Umea, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Goteborg, Sweden
- Region Västra Götaland, Children’s Heart Center, Sahlgrenska University Hospital, Goteborg, Sweden
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2
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Roy LO, Blais S, Marelli A, Dahdah N, Dancea A, Drolet C, Dallaire F. Outcomes After Pediatric Pulmonary Valve Replacement in Patients With Tetralogy of Fallot. Can J Cardiol 2024:S0828-282X(24)00441-0. [PMID: 38889848 DOI: 10.1016/j.cjca.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND People with tetralogy of Fallot might require a transannular patch during primary repair, which leads to pulmonary valve regurgitation. Pulmonary valve replacement (PVR) is performed to prevent complications of chronic pulmonary regurgitation, but the optimal timing of PVR remains a matter of debate. In this study we aimed to assess the association of PVR performed in children younger than 18 years of age with the rate of hospitalizations, interventions, and mortality. METHODS This was a retrospective observational cohort of people with tetralogy of Fallot born in Québec between 1982 and 2015, using a combination of clinical and administrative data. Marginal means and rates models and survival curves were used to compare outcomes of patients with pediatric PVR (younger than 18 years) and those without. Outcomes of interest were rates of cardiac hospitalizations, all-cause hospitalizations, cardiac interventions, and mortality. Groups were balanced using models weighed on the inverse probability of receiving pediatric PVR. RESULTS Of the 316 eligible patients, 58 (18.4%) received a pediatric PVR. Compared with patients who did not receive pediatric PVR, they were at increased risk of cardiac hospitalizations, although the rates of cardiac hospitalization were low: 0.50 vs 0.09 hospitalizations per 20 years (hazard ratio [HR] = 4.71 [95% confidence interval (CI), 2.22-9.96]). Patients who received a pediatric PVR had a comparable risk of all-cause hospitalizations (HR = 0.95 [95% CI, 0.71-1.26]) and of cardiac interventions (HR = 1.13 [95% CI, 0.72-1.77]). CONCLUSIONS Patients who underwent pediatric PVR had higher rates of cardiac hospitalizations, but similar rates of all-cause hospitalizations, cardiac procedures, and mortality. In this observational cohort, pediatric PVR was not associated with an improved outcome.
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Affiliation(s)
- Louis-Olivier Roy
- Department of Pediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Samuel Blais
- Department of Pediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montréal, Québec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Adrian Dancea
- Division of Cardiology, Montreal Children's Hospital, McGill University Health Center, Montréal, Québec, Canada
| | - Christian Drolet
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada
| | - Frédéric Dallaire
- Department of Pediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
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Lopez C, Glassberg B, Dembar A, Riasat M, Chan A, Govindarajulu U, Hopkins KA, Zaidi AN. Transition of care in CHD: a single-centre experience: an enigma remains. Cardiol Young 2024; 34:727-733. [PMID: 37771146 DOI: 10.1017/s1047951123002548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Transition of care refers to the continuity of health care during the movement from one healthcare setting to another as care needs change during a chronic illness. We sought to describe social, demographic, and clinical factors related to successful transition in a tertiary urban care facility in patients with CHD. Patients were identified utilising the electronic medical record. Inclusion criteria were patients with CHDs aged ≥15 years seen in the paediatric cardiology clinic between 2013 and 2014. Deceased patients were excluded. Clinical and demographic variables were collected. Patient charts were reviewed in 2015-2021 to determine if included patients were a) still in paediatric cardiology care, b) transitioned to adult cardiology/adult CHD, or were c) lost to follow-up. A total of 322 patients, 53% male (N:172), 46% female (N:149) were included. Majority had moderately complex lesions (N:132, 41%). Most patients had public insurance (N:172, 53%), followed by private insurance (N:67, 21%), while 15% of patients (N:47) were uninsured. Only 49% (N = 159) had successful transition, while 22% (N = 70) continued in care with paediatric cardiology, and 29% (N = 93) were lost to follow-up. Severity of CHD (p = 0.0002), having healthcare insurance (p < .0001), presence of a defibrillator (p = 0.0028), and frequency of paediatric cardiology visits (p = 0.0005) were significantly associated with successful transition. Most patients lost to follow-up (N:42,62%) were either uninsured or had public insurance. Lack of successful transition is multifactorial, and further efforts are needed to improve the process in patients with CHD.
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Affiliation(s)
| | | | | | - Maria Riasat
- Department of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Alice Chan
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, New York, NY, USA
| | - Usha Govindarajulu
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kali A Hopkins
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, New York, NY, USA
| | - Ali N Zaidi
- Mount Sinai Adult Congenital Heart Disease Center, Mount Sinai Heart, New York, NY, USA
- Mount Sinai Children's Heart Center, Kravis Children's Hospital, New York, NY, USA
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4
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Roy LO, Blais S, Marelli A, Dahdah N, Dancea A, Drolet C, Dallaire F. Determinants and Clinical Outcomes of Patients With Tetralogy of Fallot Lost to Cardiology Follow-up. Can J Cardiol 2024; 40:411-418. [PMID: 37863391 DOI: 10.1016/j.cjca.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/21/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Various rates of loss to follow-up (LTFU) have been reported in patients with congenital heart disease, but return to follow-up is rarely considered in those analyses. Outcomes of LTFU patients are difficult to assess because the patients no longer attend cardiac care. We leveraged data from the TRIVIA cohort, which combines more than 30 years of clinical and administrative data, allowing us to study outcomes even after LTFU. METHODS This population-based cohort included 904 patients with tetralogy of Fallot (TOF) born from 1982 to 2015 in Québec, Canada. Risk factors for LTFU and outcomes were calculated by Cox models and marginal means/rates models. Outcomes of LTFU patients were compared with propensity score-matched non-LTFU patients. RESULTS The cumulative risk of experiencing 1 episode of LTFU was 50.3% at 30 years. However, return to follow-up was frequent and the proportion of patients actively followed was 85.9% at 10 years, 76.4% at 20 years, and 70.6% at 30 years. Factors associated with a reduced risk of LTFU were primary repair with conduit (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.15-0.58) and transannular patch (HR 0.60, 95% CI 0.46-0.79). LTFU patients had lower rates of cardiac hospitalisations (HR 0.49, 95% CI 0.42-0.56) and cardiac interventions (HR 0.32, 95% CI 0.25-0.42), but similar rates of cardiac mortality (HR 0.95, 95% CI 0.24-3.80). CONCLUSIONS There was a lower proportion of LTFU patients compared with previous studies. Factors associated with lower rates of LTFU were conduits and non-valve-sparing surgery. LTFU patients had lower rates of cardiac procedures and cardiac hospitalisations.
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Affiliation(s)
- Louis-Olivier Roy
- Department of Pediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Samuel Blais
- Department of Pediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montréal, Québec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada
| | - Adrian Dancea
- Division of Cardiology, Montréal Children's Hospital, McGill University Health Center, Montréal, Québec, Canada
| | - Christian Drolet
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada
| | - Frédéric Dallaire
- Department of Pediatrics, Université de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
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5
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Wright B, Fassler C, Tumin D, Sarno LA. Health System Encounters after Loss to Cardiology Follow-Up among Patients with Congenital Heart Disease. J Pediatr 2024; 268:113931. [PMID: 38311237 DOI: 10.1016/j.jpeds.2024.113931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To analyze receipt of care at other locations within a single rural academic health system after loss to follow-up in a cardiology clinic. STUDY DESIGN Patients with congenital heart defects seen in the clinic during 2018 and subsequently lost to cardiology follow-up were included in the study. We defined loss to follow-up as not being seen in the clinic for at least 6 months past the most recently recommended follow-up visit. Subsequent visits to other locations, including other subspecialty clinics, primary care clinics, the emergency department, and the hospital, were tracked through 2020. RESULTS Of 235 patients (median age 7 years, 136/99 female/male), 96 (41%) were seen elsewhere in the health system. Of 96 patients with any follow-up, 40 were seen by a primary care provider and 46 by another specialist; 44 were seen in the emergency department and 12 more were hospitalized. Patients with medical comorbidities or Medicaid insurance and those living closer to the clinic were more likely to continue receiving care within the same health system. CONCLUSIONS Patients with congenital heart defect are frequently lost to cardiology follow-up. Our study supports collaboration across specialties and between cardiology clinics and affiliated emergency departments to identify patients with congenital heart defect who have been lost to cardiology follow-up but remain within the health system. A combination of in-person and remote outreach to these patients may help them continue cardiology care.
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Affiliation(s)
- Brandon Wright
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Carly Fassler
- Brody School of Medicine at East Carolina University, Greenville, NC
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Lauren A Sarno
- Division of Pediatric Cardiology, Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC.
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Sanz JH, Cox S, Donofrio MT, Ishibashi N, McQuillen P, Peyvandi S, Schlatterer S. [Formula: see text] Trajectories of neurodevelopment and opportunities for intervention across the lifespan in congenital heart disease. Child Neuropsychol 2023; 29:1128-1154. [PMID: 36752083 PMCID: PMC10406974 DOI: 10.1080/09297049.2023.2173162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023]
Abstract
Children with congenital heart disease (CHD) are at increased risk for neurodevelopmental challenges across the lifespan. These are associated with neurological changes and potential acquired brain injury, which occur across a developmental trajectory and which are influenced by an array of medical, sociodemographic, environmental, and personal factors. These alterations to brain development lead to an array of adverse neurodevelopmental outcomes, which impact a characteristic set of skills over the course of development. The current paper reviews existing knowledge of aberrant brain development and brain injury alongside associated neurodevelopmental challenges across the lifespan. These provide a framework for discussion of emerging and potential interventions to improve neurodevelopmental outcomes at each developmental stage.
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Affiliation(s)
- Jacqueline H Sanz
- Division of Neuropsychology, Children's National Hospital, Washington, D.C
- Departments of Psychiatry and Behavioral Sciences & Pediatrics at The George Washington University School of Medicine
| | - Stephany Cox
- Department of Pediatrics, Division of Developmental Medicine, Benioff Children's Hospital, University of California, San Francisco, CA
| | - Mary T Donofrio
- Division of Cardiology, Children's National Health System, Washington, D.C
- Department of Pediatrics at The George Washington University School of Medicine
| | - Nobuyuki Ishibashi
- Department of Pediatrics at The George Washington University School of Medicine
- Center for Neuroscience Research, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington D.C
| | - Patrick McQuillen
- Department of Pediatrics, Division of Developmental Medicine, Benioff Children's Hospital, University of California, San Francisco, CA
| | - Shabnam Peyvandi
- Department of Pediatrics, Division of Developmental Medicine, Benioff Children's Hospital, University of California, San Francisco, CA
| | - Sarah Schlatterer
- Department of Pediatrics at The George Washington University School of Medicine
- Prenatal Pediatrics Institute, Children's National Hospital, Washington, D.C
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, D.C
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7
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Andrews JG, Strah D, Downing KF, Kern MC, Oster ME, Seckeler MD, Goudie A, Nembhard WN, Farr SL, Klewer SE. Cardiology Care and Loss to Follow-Up Among Adults With Congenital Heart Defects in CH STRONG. Am J Cardiol 2023; 197:42-45. [PMID: 37148718 PMCID: PMC10236354 DOI: 10.1016/j.amjcard.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/22/2023] [Accepted: 04/03/2023] [Indexed: 05/08/2023]
Abstract
Many of the estimated 1.4 million adults with congenital heart defects (CHDs) in the United States are lost to follow-up (LTF) despite recommendations for ongoing cardiology care. Using 2016 to 2019 CH STRONG (Congenital Heart Survey To Recognize Outcomes, Needs, and well-beinG) data, we describe cardiac care among community-based adults with CHD, born in 1980 to 1997, identified through state birth defects registries. Our estimates of LTF were standardized to the CH STRONG eligible population and likely more generalizable to adults with CHD than clinic-based data. Half of our sample were LTF and more than 45% had not received cardiology care in over 5 years. Of those who received care, only 1 in 3 saw an adult CHD physician at their last encounter. Not knowing they needed to see a cardiologist, being told they no longer needed cardiology care, and feeling "well" were the top reasons for LTF, and only half of respondents report doctors discussing the need for cardiac follow-up.
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Affiliation(s)
| | - Danielle Strah
- Department of Pediatrics, University of Arizona, Tucson, Arizona
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew C Kern
- School of Medicine, University of Arizona, Tucson, Arizona
| | - Matthew E Oster
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | - Anthony Goudie
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Wendy N Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott E Klewer
- Department of Pediatrics, University of Arizona, Tucson, Arizona
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Burger D, Denfeld QE, Evers PD, Ward P, Woods P, Hasan R. Referral Order Placement Decreases Time to Transfer to Adult Congenital Heart Disease Care. Pediatr Cardiol 2023:10.1007/s00246-023-03164-3. [PMID: 37103492 DOI: 10.1007/s00246-023-03164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023]
Abstract
Pediatric patients with moderate and great complexity congenital heart disease (CHD) may benefit from coordinated transfer to adult congenital heart disease (ACHD) centers to reduce the risk of complications; however, there are a variety of transfer practices. We examined the impact of referral order placement at the last pediatric cardiology visit on time to transfer to an ACHD center. We analyzed data collected from pediatric patients with moderate and great complexity CHD who were eligible to transfer to our tertiary center's accredited ACHD center. We examined transfer outcomes and time-to-transfer between those with a referral order placed at the last pediatric cardiology visit and those without using Cox proportional hazards modeling. The sample (n = 65) was 44.6% female and mean age at study start was 19.5 years (± 2.2). Referral orders were placed for 32.3% of patients at the last pediatric cardiology visit. Those who had a referral order placed at the last visit had significantly higher number of successful transfers to the ACHD center compared to those who did not (95% vs 25%, p < 0.001). In a Cox regression model, placement of a referral order at the last pediatric cardiology visit was associated significantly with a sooner time to transfer (HR 6.0; 95% CI 2.2-16.2, p > 0.001), adjusting for age, sex, complexity, living location, and pediatric cardiology visit location. Placement of a referral order at the last pediatric cardiology visit may improve transfer occurrence and time to transfer to accredited ACHD centers.
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Affiliation(s)
- Debora Burger
- Oregon Health & Science University School of Nursing, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR, 97239-2941, USA.
| | - Quin E Denfeld
- Oregon Health & Science University School of Nursing, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR, 97239-2941, USA
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Patrick D Evers
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - Pam Ward
- Division of Pediatric Cardiology, Oregon Health & Science University, Portland, OR, USA
| | - Patricia Woods
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Reem Hasan
- Departments of Internal Medicine and Pediatrics, Oregon Health & Science University, Portland, OR, USA
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Bassareo PP, Mcmahon CJ, Prendiville T, James A, Roberts P, Oslizlok P, Walsh MA, Kenny D, Walsh KP. Planning Transition of Care for Adolescents Affected by Congenital Heart Disease: The Irish National Pathway. Pediatr Cardiol 2023; 44:24-33. [PMID: 35737012 DOI: 10.1007/s00246-022-02955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/08/2022] [Indexed: 01/24/2023]
Abstract
At some point in their life, adolescent patients with a congenital heart disease (CHD) transition from paediatric services to adult care facilities. The process is not without any risks, as it is often linked with a significantly progressive deterioration in adolescents' health and loss of follow-up. In fact, transition patients often encounter troubles in finding a care giver who is comfortable managing their condition, or in re-establishing trust with the new care provider. Planning the rules of transition is pivotal in preventing these risks. Unfortunately, the American and European guidelines on CHD provide just generic statements about transition. In a recently published worldwide inter-societies consensus document, a hybrid model of transition, which should be adapted for use in high- and low- resource settings, has been suggested. Currently, in literature there are a few models of transition for CHD patients, but they are by far local models and cannot be generalized to other regions or countries. This paper describes the Irish model for transition of care of CHD patients. Due to the peculiarity of the healthcare organization in the Republic of Ireland, which is centralized with one main referral centre for paediatric cardiology (in Dublin, with a few smaller satellite centres all around, according to the "hub and spoke" model) and one centre for adult with CHD (in Dublin), the model can be considered as a national one and the first to be released in the old continent.
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Affiliation(s)
- Pier Paolo Bassareo
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland. .,Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland. .,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland.
| | - Colin Joseph Mcmahon
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Terence Prendiville
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Adam James
- Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Phil Roberts
- Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Paul Oslizlok
- Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Mark Anthony Walsh
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
| | - Damien Kenny
- Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland.,Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Kevin Patrick Walsh
- School of Medicine, University College of Dublin, Dublin, Republic of Ireland.,Mater Misericordiae University Hospital, Eccles St, Inns Quay, Dublin 7, Dublin, D07 R2WY, Republic of Ireland.,Children's Health Ireland (CHI) at Crumlin, Dublin, Republic of Ireland
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10
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Espuny Pujol F, Franklin RC, Crowe S, Brown KL, Swan L, Pagel C, English KM. Transfer of congenital heart patients from paediatric to adult services in England. Heart 2022; 108:1964-1971. [PMID: 35794015 DOI: 10.1136/heartjnl-2022-321085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/16/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study assessed the transfer of patients from paediatric cardiac to adult congenital heart disease (ACHD) services in England and the factors impacting on this process. METHODS This retrospective cohort study used a population-based linked data set (LAUNCHES QI data set: 'Linking Audit and National datasets in Congenital Heart Services for Quality Improvement') including all patients born between 1987 and 2000, recorded as having a congenital heart disease (CHD) procedure in childhood. Hospital Episode Statistics data identified transfer from paediatric to ACHD services between the ages of 16 and 22 years. RESULTS Overall, 63.8% of a cohort of 10 298 patients transferred by their 22nd birthday. The estimated probability of transfer by age 22 was 96.5% (95% CI 95.3 to 97.7), 86.7% (95% CI 85.6 to 87.9) and 41.0% (95% CI 39.4 to 42.6) for severe, moderate and mild CHD, respectively. 166 patients (1.6%) died between 16 and 22 years; 42 of these (0.4%) died after age 16 but prior to transfer. Multivariable ORs in the moderate and severe CHD groups up to age 20 showed significantly lower likelihood of transfer among female patients (0.87, 95% CI 0.78 to 0.97), those with missing ethnicity data (0.31, 95% CI 0.18 to 0.52), those from deprived areas (0.84, 95% CI 0.72 to 0.98) and those with moderate (compared with severe) CHD (0.30, 95% CI 0.26 to 0.35). The odds of transfer were lower for the horizontal compared with the vertical care model (0.44, 95% CI 0.27 to 0.72). Patients who did not transfer had a lower probability of a further National Congenital Heart Disease Audit procedure between ages 20 and 30 compared with those who did transfer: 12.3% (95% CI 5.1 to 19.6) vs 32.5% (95% CI 28.7 to 36.3). CONCLUSIONS Majority of patients with moderate or severe CHD in England transfer to adult services. Patients who do not transfer undergo fewer elective CHD procedures over the following decade.
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Affiliation(s)
| | - Rodney C Franklin
- Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, UCL, London, UK
| | - Kate L Brown
- Cardiorespiratory, GOSH, London, UK.,Heart and Lung Division, Great Ormond Street Hospital NIHR Biomedical Research Centre', London, UK
| | - Lorna Swan
- Adult Congenital Heart Disease, Golden Jubilee National Hospital, Glasgow, UK
| | | | - Kate M English
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Davidse K, van Staa A, Geilvoet W, van Eck JP, Pellikaan K, Baan J, Hokken-Koelega ACS, van den Akker ELT, Sas T, Hannema SE, van der Lely AJ, de Graaff LCG. We mind your step: understanding and preventing drop-out in the transfer from paediatric to adult tertiary endocrine healthcare. Endocr Connect 2022; 11:e220025. [PMID: 35521816 PMCID: PMC9175586 DOI: 10.1530/ec-22-0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022]
Abstract
Introduction Transition from paediatric to adult endocrinology can be challenging for adolescents, their families and healthcare professionals. Previous studies have shown that up to 25% of young adults with endocrine disorders are lost to follow-up after moving out of paediatric care. This poses a health risk for young adults, which can lead to serious and expensive medical acute and long-term complications. Methods In order to understand and prevent dropout, we studied electronic medical records of patients with endocrine disorders. These patients were over 15 years old when they attended the paediatric endocrine outpatient clinic (OPC) of our hospital in 2013-2014 and should have made the transfer to adult care at the time of the study. Results Of 387 adolescents, 131 had an indication for adult follow-up within our university hospital. Thirty-three (25%) were lost to follow-up. In 24 of them (73%), the invitation for the adult OPC had never been sent. We describe the failures in logistic processes that eventually led to dropout in these patients. Conclusion We found a 25% dropout during transfer from paediatric to adult tertiary endocrine care. Of all dropouts, 73% could be attributed to the failure of logistic steps. In order to prevent these dropouts, we provide practical recommendations for patients and paediatric and adult endocrinologists.
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Affiliation(s)
- Kirsten Davidse
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anneloes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Wanda Geilvoet
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Judith P van Eck
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Karlijn Pellikaan
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Janneke Baan
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anita C S Hokken-Koelega
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Academic Centre for Growth, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Dutch Growth Research Foundation, Rotterdam, the Netherlands
| | - Erica L T van den Akker
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Theo Sas
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Diabeter, National Diabetes Care and Research Centre, Rotterdam, the Netherlands
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Aart Jan van der Lely
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Laura C G de Graaff
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Academic Centre for Growth, Erasmus University Medical Centre, Rotterdam, the Netherlands
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12
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Skogby S, Bratt EL, Johansson B, Moons P, Goossens E. Discontinuation of follow-up care for young people with complex chronic conditions: conceptual definitions and operational components. BMC Health Serv Res 2021; 21:1343. [PMID: 34911550 PMCID: PMC8672472 DOI: 10.1186/s12913-021-07335-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background A substantial proportion of young people with Complex Chronic Conditions (CCCs) experience some degree of discontinuation of follow-up care, which is an umbrella term to describe a broken chain of follow-up. Discontinuation of follow-up care is not clearly defined, and the great plethora of terms used within this field cannot go unnoticed. Terms such as “lost to follow-up”, “lapses in care” and “care gaps”, are frequently used in published literature, but differences between terms are unclear. Lack of uniformity greatly affects comparability of study findings. The aims of the present study were to (i) provide a systematic overview of terms and definitions used in literature describing discontinuation of follow-up care in young people with CCC’s; (ii) to clarify operational components of discontinuation of follow-up care (iii); to develop conceptual definitions and suggested terms to be used; and (iv) to perform an expert-based evaluation of terms and conceptual definitions. Methods A systematic literature search performed in PubMed was used to provide an overview of current terms used in literature. Using a modified summative content analysis, operational components were analysed, and conceptual definitions were developed. These conceptual definitions were assessed by an expert panel using a survey. Results In total, 47 terms and definitions were retrieved, and a core set of operational components was identified. Three main types of discontinuation of follow-up care emerged from the analysis and expert evaluation, conceptually defined as follows: Lost to follow-up care: “No visit within a defined time period and within a defined context, and the patient is currently no longer engaged in follow-up care”;Gap in follow-up care: “Exceeded time interval between clinic visits within a defined context, and the patient is currently engaged in follow-up care”; andUntraceability: “Failure to make contact due to lack of contact information”. Conclusion By creating a common vocabulary for discontinuation of follow-up care, the quality of future studies could improve. The conceptual definitions and operational components provide guidance to both researchers and healthcare professionals focusing on discontinuation of follow-up care for young people with CCCs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07335-x.
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Affiliation(s)
- Sandra Skogby
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Gothenburg, Sweden. .,KU Leuven Department of Public Health and Primary Care, Leuven, Belgium.
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Bengt Johansson
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,KU Leuven Department of Public Health and Primary Care, Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium.,Center for Research and Innovation in Care, Faculty of Nursing, University of Antwerp, Antwerp, Belgium.,Department of Patient Care Services, Antwerp University Hospital, Antwerp, Belgium
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13
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Skogby S, Goossens E, Johansson B, Moons P, Bratt EL. Qualitative study of facilitators and barriers for continued follow-up care as perceived and experienced by young people with congenital heart disease in Sweden. BMJ Open 2021; 11:e049556. [PMID: 34706951 PMCID: PMC8552172 DOI: 10.1136/bmjopen-2021-049556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
UNLABELLED In-depth understanding of factors perceived by young people with congenital heart disease (CHD) to affect continued follow-up care is needed to tailor preventive strategies for discontinuation of follow-up care. To identify facilitating factors, low-prevalence settings in terms of discontinuation should be investigated. OBJECTIVE This qualitative study describes factors affecting continued follow-up as perceived and experienced by young adults with CHD. PARTICIPANTS Using a mixed purposive sampling technique, 16 young adults with CHD were included. Three participants had discontinued follow-up care and 13 had continued follow-up care after transfer. SETTING Participants were recruited from all seven university hospitals in Sweden, which is considered a low-prevalence setting in terms of discontinuation. DESIGN Individual interviews were performed and subjected to qualitative content analysis. RESULTS The analysis resulted in three main categories, illuminating factors affecting continued follow-up: (1) motivation for follow-up care; (2) participation in care and sense of connectedness with healthcare provider (HCP) and (3) care accessibility. The choice of continuing follow-up or not was multifactorial. Knowledge of your CHD and the importance of continuing follow-up care was a central factor, as well as experiencing CHD-related symptoms and having ongoing or planned medical treatment or interventions. Sensing a clear purpose with follow-up care was facilitating, as was feeling well treated and cared for by HCPs. Practical aspects, such as travel distance was also stressed, as well as active invitations and reminders for visits. CONCLUSION Factors on both patient, hospital and healthcare system level were raised by participants, stressing the importance of holistic approaches when developing preventive strategies for discontinuation. There is a need for improved skills and competencies among HCPs, as well as a person-centred approach to follow-up care. In addition, specific healthcare needs and remaining transitional needs after transfer to adult care require careful consideration to prevent discontinuation.
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Affiliation(s)
- Sandra Skogby
- University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
- KU Leuven Department of Public Health and Primary Care, Leuven, Flanders, Belgium
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, Leuven, Flanders, Belgium
- Center for Research and Innovation in Care, Faculty of Nursing, University of Antwerp, Antwerp, Belgium
| | - Bengt Johansson
- Heart Centre and Department of Surgery and Perioperative Sciences, Umeå University, Umea, Sweden
| | - Philip Moons
- University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
- KU Leuven Department of Public Health and Primary Care, Leuven, Flanders, Belgium
| | - Ewa-Lena Bratt
- University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden
- Department of Pediatric Cardiology, Queen Silvia Children's Hospital, Gothenburg, Sweden
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14
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ACG Clinical Report and Recommendations on Transition of Care in Children and Adolescents With Hereditary Polyposis Syndromes. Am J Gastroenterol 2021; 116:638-646. [PMID: 33982929 DOI: 10.14309/ajg.0000000000001140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transition of care (TOC) in adolescents and young adults (AYAs) with chronic gastrointestinal disorders has received increased attention, especially in those with inflammatory bowel disease. AYAs with hereditary polyposis syndromes are a heterogeneous group of patients with overlapping and complex medical needs. These patients are particularly vulnerable because of the risk of loss of continuity of care and subsequent poor disease outcomes. The Pediatric Committee of the American College of Gastroenterology commissioned a report with recommendations on TOC in AYAs with hereditary polyposis syndromes. This report aims at achieving best practice by both pediatric and adult gastroenterologists despite the paucity of published evidence in this population reflected in the included PRISMA report. Therefore, the group extrapolated findings from the literature related to other chronic gastrointestinal disorders, and a high degree of expert consensus was scored for all recommendations. The report addresses TOC through identifying shared domains followed by specific recommendations in disease management, including models of care, providers and patient and socioeconomic factors relevant to TOC. Areas of strong emphasis include the need for early planning, flexibility in the transition process to maintain continuity during major surgical procedures, patient and family psychological readiness, liaison among team members addressing transition, and changing insurance coverage in this population.
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15
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Moons P, Skogby S, Bratt EL, Zühlke L, Marelli A, Goossens E. Discontinuity of Cardiac Follow-Up in Young People With Congenital Heart Disease Transitioning to Adulthood: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e019552. [PMID: 33660532 PMCID: PMC8174191 DOI: 10.1161/jaha.120.019552] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The majority of people born with congenital heart disease require lifelong cardiac follow-up. However, discontinuity of care is a recognized problem and appears to increase around the transition to adulthood. We performed a systematic review and meta-analysis to estimate the proportion of adolescents and emerging adults with congenital heart disease discontinuing cardiac follow-up. In pooled data, we investigated regional differences, disparities by disease complexity, and the impact of transition programs on the discontinuity of care. Methods and Results Searches were performed in PubMed, Embase, Cinahl, and Web of Science. We identified 17 studies, which enrolled 6847 patients. A random effects meta-analysis of single proportions was performed according to the DerSimonian-Laird method. Moderator effects were computed to explore sources for heterogeneity. Discontinuity proportions ranged from 3.6% to 62.7%, with a pooled estimated proportion of 26.1% (95% CI, 19.2%-34.6%). A trend toward more discontinuity was observed in simple heart defects (33.7%; 95% CI, 15.6%-58.3%), compared with moderate (25.7%; 95% CI, 15.2%-40.1%) or complex congenital heart disease (22.3%; 95% CI, 16.5%-29.4%) (P=0.2372). Studies from the United States (34.0%; 95% CI, 24.3%-45.4%), Canada (25.7%; 95% CI, 17.0%-36.7%), and Europe (6.5%; 95% CI, 5.3%-7.9%) differed significantly (P=0.0004). Transition programs were shown to have the potential to reduce discontinuity of care (12.7%; 95% CI, 2.8%-42.3%) compared with usual care (36.2%; 95% CI, 22.8%-52.2%) (P=0.1119). Conclusions This meta-analysis showed that there is a high proportion of discontinuity of care in young people with congenital heart disease. The highest discontinuity proportions were observed in studies from the United States and in patients with simple heart defects. It is suggested that transition programs have a protective effect. Registration URL: www.crd.york.ac.uk/prospero. Unique identifier: CRD42020182413.
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Affiliation(s)
- Philip Moons
- Department of Public Health and Primary Care KU Leuven Belgium.,Institute of Health and Care SciencesUniversity of Gothenburg Sweden.,Department of Pediatrics and Child Health University of Cape Town South Africa
| | - Sandra Skogby
- Department of Public Health and Primary Care KU Leuven Belgium.,Institute of Health and Care SciencesUniversity of Gothenburg Sweden.,Department of Pediatric Cardiology Queen Silvia's Children's HospitalUniversity of Gothenburg Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care SciencesUniversity of Gothenburg Sweden.,Department of Pediatric Cardiology Queen Silvia's Children's HospitalUniversity of Gothenburg Sweden
| | - Liesl Zühlke
- Department of Pediatrics and Child Health University of Cape Town South Africa.,Division of Cardiology Groote Schuur HospitalFaculty of Health SciencesUniversity of Cape Town South Africa
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit) McGill University Health Center Montreal QC Canada
| | - Eva Goossens
- Department of Public Health and Primary Care KU Leuven Belgium.,Research Foundation Flanders (FWO) Brussels Belgium.,Faculty of Medicine and Health Sciences Centre for Research and Innovation in Care Division of Nursing and Midwifery University of Antwerp Belgium
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16
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Hsu WH, Sommerhalter KM, McGarry CE, Farr SL, Downing KF, Lui GK, Zaidi AN, Hsu DT, Van Zutphen AR. Inpatient admissions and costs for adolescents and young adults with congenital heart defects in New York, 2009-2013. Birth Defects Res 2020; 113:173-188. [PMID: 32990389 DOI: 10.1002/bdr2.1809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Most individuals born with congenital heart defects (CHDs) survive to adulthood, but healthcare utilization patterns for adolescents and adults with CHDs have not been well described. We sought to characterize the healthcare utilization patterns and associated costs for adolescents and young adults with CHDs. METHODS We examined 2009-2013 New York State inpatient admissions of individuals ages 11-30 years with ≥1 CHD diagnosis codes recorded during any admission. We conducted multivariate linear regression using generalized estimating equations to examine associations between inpatient costs and sociodemographic and clinical variables. RESULTS We identified 5,100 unique individuals with 9,593 corresponding hospitalizations over the study period. Median inpatient cost and length of stay (LOS) were $10,720 and 3.0 days per admission, respectively; 55.1% were emergency admissions. Admission volume increased 48.7% from 2009 (1,538 admissions) to 2013 (2,287 admissions), while total inpatient costs increased 91.8% from 2009 ($27.2 million) to 2013 ($52.2 million). Inpatient admissions and costs rose more sharply over the study period for those with nonsevere CHDs compared to severe CHDs. Characteristics associated with higher costs were longer LOS, severe CHD, cardiac/vascular hospitalization classification, surgical procedures, greater severity of illness, and admission in New York City. CONCLUSION This study provides an informative baseline of health care utilization patterns and associated costs among adolescents and young adults with CHDs in New York State. Structured transition programs may aid in keeping this population in appropriate cardiac care as they move to adulthood.
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Affiliation(s)
- Wan-Hsiang Hsu
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA
| | - Kristin M Sommerhalter
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA
| | - Claire E McGarry
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - George K Lui
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Stanford School of Medicine, Stanford, California, USA
| | - Ali N Zaidi
- Sinai Adult Congenital Heart Disease Program, Mount Sinai Cardiovascular Institute & The Pediatric Heart Center, New York, New York, USA
| | - Daphne T Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alissa R Van Zutphen
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA.,University at Albany School of Public Health, Rensselaer, New York, USA
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17
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Seidel L, Nebel K, Achenbach S, Bauer U, Ewert P, Freilinger S, Gundlach U, Kaemmerer H, Nagdyman N, Oberhoffer R, Pieper L, Reinhard W, Sanftenberg L, Schelling J, Weyand M, Neidenbach R. Facts about the General Medical Care of Adults with Congenital Heart Defects: Experience of a Tertiary Care Center. J Clin Med 2020; 9:E1943. [PMID: 32580342 PMCID: PMC7355698 DOI: 10.3390/jcm9061943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Due to the increase in survival rates for congenital heart disease (CHD) in the last decades, over 90% of patients today reach adulthood. Currently, there are more than 300,000 adults with CHD (ACHD) living in Germany. They have an increased need for specialized medical care, since almost all ACHD have chronic heart disease and suffer from specific chronic symptoms, risks, and sequelae. Primary care physicians (PCPs) play a crucial role in referring patients to ACHD specialists or specialized institutions. This cross-sectional study is intended to clarify the real-world care of ACHD from the PCP's perspective. Methods: This analysis, initiated by the German Heart Centre Munich, was based on a 27-item questionnaire on actual ACHD health care practice in Germany from the PCP's perspective. Results: In total, 767 questionnaires were considered valid for inclusion. The majority of the PCPs were general practitioners (95.9%), and 84.1% had cared for ACHD during the past year. A majority (69.2%) of the PCPs had cared for patients with simple CHD, while 50.6% and 33.4% had cared for patients with moderate and severe CHD, respectively, in all age groups. PCPs treated almost all typical residual symptoms and sequelae, and advised patients regarding difficult questions, including exercise capacity, pregnancy, genetics, and insurance matters. However, 33.8% of the PCPs did not even know about the existence of certified ACHD specialists or centers. Only 23.9% involved an ACHD-specialized physician in their treatment. In cases of severe cardiac issues, 70.8% of the PCPs referred patients to ACHD-certified centers. Although 52.5% of the PCPs were not sufficiently informed about existing structures, 64.2% rated the current care situation as either "very good" or "good". Only 26.3% (n = 190) of the responding physicians were aware of patient organizations for ACHD. Conclusions: The present study showed that the majority of PCPs are not informed about the ACHD care structures available in Germany. The need for specialized ACHD follow-up care is largely underestimated, with an urgent need for optimization to reduce morbidity and mortality. For the future, solutions must be developed to integrate PCPs more intensively into the ACHD care network.
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Affiliation(s)
- Lavinia Seidel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Kathrin Nebel
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Stephan Achenbach
- Department of Cardiology, University of Erlangen, 91054 Erlangen, Germany; (S.A.); (U.G.)
| | - Ulrike Bauer
- Competence Network for Congenital Heart Defects, 13353 Berlin, Germany;
| | - Peter Ewert
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Ulrike Gundlach
- Department of Cardiology, University of Erlangen, 91054 Erlangen, Germany; (S.A.); (U.G.)
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
| | - Renate Oberhoffer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
- Department of Preventive Paediatrics, Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
| | - Lars Pieper
- Department of Behavioural Epidemiology, Technische Universität Dresden, 01069 Dresden, Germany;
| | - Wibke Reinhard
- Cardiology Department, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany;
| | - Linda Sanftenberg
- Institute of General Practice, University of the Ludwig-Maximilians-University Munich, 80336 Munich, Germany;
| | - Jörg Schelling
- Private Group Practice Martinsried, 82152 Martinsried, Germany;
| | - Michael Weyand
- Department of Cardiac Surgery, University of Erlangen, 91054 Erlangen, Germany;
| | - Rhoia Neidenbach
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technical University Munich, 80636 Munich, Germany; (L.S.); (K.N.); (P.E.); (S.F.); (H.K.); (N.N.); (R.O.)
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18
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Skogby S, Moons P, Johansson B, Sunnegårdh J, Christersson C, Nagy E, Winberg P, Hanséus K, Trzebiatowska-Krzynska A, Fadl S, Fernlund E, Kazamia K, Rydberg A, Zühlke L, Goossens E, Bratt EL. Outpatient volumes and medical staffing resources as predictors for continuity of follow-up care during transfer of adolescents with congenital heart disease. Int J Cardiol 2020; 310:51-57. [PMID: 31959410 DOI: 10.1016/j.ijcard.2020.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/06/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Providing continuous follow-up care to patients with congenital heart disease (CHD) remains a challenge in many settings. Previous studies highlight that patients with CHD experience discontinuation of follow-up care, but mainly describe a single-centre perspective, neglecting inter-institutional variations. Hospital-related factors above and beyond patient-related factors are believed to affect continuity of care. The present multicentre study therefore investigated (i) proportion of "no follow-up care"; (ii) transfer destinations after leaving paediatric cardiology; (iii) variation in proportions of no follow-up between centres; (iv) the association between no follow-up and outpatient volumes, and (v) its relationship with staffing resources at outpatient clinics. METHODS An observational, multicentre study was conducted in seven university hospitals. In total, 654 adolescents with CHD, born between 1991 and 1993, with paediatric outpatient visit at age 14-18 years were included. Transfer status was determined 5 years after the intended transfer to adult care (23y), based on medical files, self-reports and registries. RESULTS Overall, 89.7% of patients were receiving adult follow-up care after transfer; 6.6% had no follow-up; and 3.7% were untraceable. Among patients in follow-up care, only one remained in paediatric care and the majority received specialist adult CHD care. Significant variability in proportions of no follow-up were identified across centres. Higher outpatient volumes at paediatric outpatient clinics were associated with better continued follow-up care after transfer (OR = 1.061; 95% CI = 1.001 - 1.124). Medical staffing resources were not found predictive. CONCLUSION Our findings support the theory of hospital-related factors influencing continuity of care, above and beyond patient-related characteristics.
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Affiliation(s)
- Sandra Skogby
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Gothenburg, Sweden; Department of Paediatric Cardiology, Queen Silvia's Children's Hospital, Rondvägen 10, 416 50 Gothenburg, Sweden; KU Leuven Department of Public Health and Primary Care, Kapucijnenvoer 35, PB 7001, 3000 Leuven, Belgium
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Gothenburg, Sweden; KU Leuven Department of Public Health and Primary Care, Kapucijnenvoer 35, PB 7001, 3000 Leuven, Belgium; Department of Paediatrics and Child Health, University of Cape Town, Klipfrontein Road Mowbray, Cape Town 7700, South Africa
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine, Umeå University, 90185 Umeå, Sweden
| | - Jan Sunnegårdh
- Department of Paediatric Cardiology, Queen Silvia's Children's Hospital, Rondvägen 10, 416 50 Gothenburg, Sweden
| | - Christina Christersson
- Department of Medical Sciences, Cardiology, Uppsala University, Sjukhusvägen 7, 753 09 Uppsala, Sweden
| | - Edit Nagy
- Heart and Vascular Theme, Congenital Heart Disease Group, Karolinska University Hospital, Stockholm, 171 76 Solna, Sweden
| | - Per Winberg
- Department of Paediatric Cardiology, Karolinska University Hospital, Eugeniavägen 23 C8:34, 17176 Stockholm, Sweden
| | - Katarina Hanséus
- Department of Paediatric Cardiology, Skåne University Hospital, Barnhjärtcentrum avd 67, 221 85 Lund, Sweden
| | - Aleksandra Trzebiatowska-Krzynska
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Sjukhusvägen, 581 85 Linköping, Sweden; Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Sjukhusvägen, 58185 Linköping, Sweden
| | - Shalan Fadl
- Department of Paediatric and Women's Health Care, Örebro University Hospital, 701 85 Örebro, Sweden
| | - Eva Fernlund
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Crown Princess Victoria Children's Hospital, Linköping University, 581 85 Linköping, Sweden; Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Department of Paediatric Cardiology, 221 85 Lund, Sweden
| | - Kalliopi Kazamia
- Department of Paediatric Cardiology, Uppsala University, Sjukhusvägen 85, 75185 Uppsala, Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Unit of Paediatrics, Umeå University, Umeå University Hospital, 90185 Umeå, Sweden
| | - Liesl Zühlke
- Division of Paediatric Cardiology, Department of Paediatric and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, Klipfrontein Road Mowbray, Cape Town 7700, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Anzio Road Mowbray, Cape Town 7700, South Africa
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, Kapucijnenvoer 35, PB 7001, 3000 Leuven, Belgium; Research Foundation Flanders (FWO), Egmontstraat 5, 1030 Brussels, Belgium
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Gothenburg, Sweden; Department of Paediatric Cardiology, Queen Silvia's Children's Hospital, Rondvägen 10, 416 50 Gothenburg, Sweden.
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