Health Care Utilization, Transition Readiness, and Quality of Life: A Latent Class Analysis

Transitions of care for adolescents with disorders of gut-brain interaction

OBJECTIVES

Little is known about the experience of adolescents and young adults (AYA) with disorders of gut-brain interaction (DGBI) who transition from pediatric to adult gastroenterology care. In this two-part study, we used quantitative and qualitative methods to: (1) assess incidence of optimal versus suboptimal transitions of care for AYA with DGBI, (2) characterize health and quality of life effects of the transition, and (3) identify barriers and facilitators for optimal transition of care.

METHODS

In Part 1, we conducted a retrospective review of AYA referrals to our adult neurogastroenterology clinic who had transitioned from pediatric gastroenterology care (N = 109, 17-23 years, 72% female). We collected demographic, psychosocial, and healthcare utilization data to determine rate and risk factors for suboptimal transitions. In Part 2, we recruited 24 AYA and parents (n = 19 AYA, n = 5 parents) for completion of a survey and semistructured interview, which was analyzed using validated rapid qualitative analysis method.

RESULTS

In Part 1, 20% (22/109) of AYA met the criteria for suboptimal transition of care, which was associated with treatment adherence concern and functional impairment. In Part 2, we identified two principal themes: (1) AYA's health and quality of life are impacted during the transition, and (2) parental involvement and collaboration with pediatric gastrointestinal are facilitators to successful transitions, whereas access to care and practice style change are barriers.

CONCLUSION

AYA with DGBI have high rates of suboptimal care transitions, affecting their health and quality of life. Our study highlights the need for a comprehensive approach that incorporates parents and pediatric providers.

Associations between tripartite dimensions of internalizing symptoms and transition readiness in a sample of emerging adults with and without chronic physical health conditions

OBJECTIVE

Theoretical models note psychosocial functioning as a key influence on transition readiness skills (TRS) among emerging adults (EA), but little is known about the relative importance of unique vs. shared anxiety and depressive dimensions, operationalized according to Clark and Watson's (1991) tripartite model, in contributing to TRS. Moreover, although development of TRS is important for all EA, few studies have examined whether the strength of relationships between internalizing symptoms and TRS vary between EA with and without chronic physical health conditions (CHC). Given the links between suboptimal TRS and adverse health outcomes, additional research is needed. This study examined individual and additive associations between three internalizing symptom dimensions (anxious arousal, anhedonic depression, and general distress) and TRS, as well as the moderating role of CHC status.

METHOD

One hundred twenty-six EA completed an online survey measuring TRS and internalizing symptoms. The sample was 70.6% women, 39.7% of minoritized racial identity, and 21.2% Hispanic ethnicity. The mean participant age was 21.23 years.

RESULTS

In two of three regression models, anhedonic depression alone was significantly related to TRS. CHC moderated the relationship between internalizing and TRS in only two of nine models. In both cases, internalizing symptoms were negatively associated with TRS for those without CHCs, but not for those with CHCs.

CONCLUSIONS

Assessment of anhedonic depression may be particularly useful in identifying youth at risk for suboptimal TRS regardless of CHC status. Moreover, interventions such as behavioral activation to improve TRS skill attainment warrant additional investigation.

Health-related quality of life and self-reported health status in adolescents with chronic health conditions before transfer of care to adult health care: an international cohort study

BACKGROUND

Heath-related quality of life (HRQoL) is lower in adolescents with chronic health conditions compared to healthy peers. While there is evidence of some differences according to the underlying condition and gender, differences by measure and country are poorly understood. In this study we focus on the differences in HRQoL in adolescents with various chronic medical conditions in the year before transfer of care to adult health services. We also study the associations of two different HRQoL measurements to each other and to self-reported health.

METHODS

We recruited 538 adolescents from New Children`s Hospital, Helsinki, Finland, and the Royal Children`s Hospital, Melbourne, Australia in 2017-2020. We used two validated HRQoL measurement instruments, Pediatric Quality of Life Inventory (PedsQL) and 16D, and a visual analog scale (VAS) for self-reported health status.

RESULTS

In total, 512 adolescents (50.4% female, mean age 17.8 [SD 1.2] years), completed the survey measures. Higher HRQoL was reported in males than females in both countries (PedsQL 79.4 vs. 74.1; 16D 0.888 vs. 0.846), and in adolescents from Finland than Australia (80.6 vs. 72.2 and 0.905 vs. 0.825, p < 0.001 for all). Adolescents with diabetes, rheumatological, nephrological conditions and/or organ transplants had higher HRQoL than adolescents with neurological conditions or other disease syndromes (p < 0.001). PedsQL and 16D scores showed a strong correlation to each other (Spearman correlation coefficient r = 0.81). Using the 7-point VAS (1-7), 52% (248 of 479) considered their health status to be good (6-7) and 10% (48 of 479) rated it poor (1-2). Better self-reported health was associated with higher HRQoL.

CONCLUSIONS

The HRQoL of transition aged adolescents varies between genders, diagnostic groups, and countries of residence. The association between self-reported health and HRQoL suggests that brief assessment using the VAS could identify adolescents who may benefit from in-depth HRQoL evaluation.

TRIAL REGISTRATION

Trial registration name The Bridge and registration number NCT04631965 ( https://clinicaltrials.gov/ct2/show/NCT04631965 ).

The Moderating Role of Health Status on the Association Between Depressive Symptoms and Cannabis Vaping

Objective

Cannabis vaping is increasing among college students. There is little information on risk factors for vaping cannabis. Consistent with the self-medication hypothesis, experiencing depressive symptoms and having a chronic medical condition (CMC) are associated with cannabis use among young adults. Individuals who experience both risk factors may be at higher risk for cannabis vaping. This study examined cross-sectional associations between depressive symptoms, CMC status, and cannabis vaping, and identified the moderating role of CMC status on depressive symptoms and cannabis vaping.

Method

College students (N = 3,742) self-reported on depressive symptoms, CMC status, and lifetime and current cannabis vaping (i.e., cannabis vaporizers; electronic nicotine devices to use cannabis). Data were collected Fall 2017 until Spring 2021. The sample was predominantly female (70.9%) and White (75.4%). Regression analyses were used.

Results

Greater depressive symptoms were related to increased likelihood of cannabis vaping across outcomes. Having a CMC was related to lifetime history of cannabis vaporizing. CMC status moderated the associations between depressive symptoms and lifetime cannabis vaporizing. Depressive symptoms were only a risk factor for cannabis vaporizing among college students without a CMC, not those with a CMC.

Conclusions

Interventions that teach adaptive ways of coping with depressive symptoms and the potential demands of managing a CMC in college are needed. Comprehensive programs for college students, with and without CMCs, are needed to support those with comorbid depression and cannabis vaping use.

Clinical, Sociodemographic, and Psychological Factors Associated with Transition Readiness in Patients with Epilepsy

BACKGROUND

The transition to adult care for patients with epilepsy is a complicated clinical issue associated with adverse outcomes, including non-adherence to treatment, dropout of medical care, and worse prognosis. Moreover, youngsters with epilepsy are notably prone to emotional, psychological, and social difficulties during the transition to adulthood. Transition needs depend on the type of epilepsy and the epileptic syndrome, as well as on the presence of co-morbidities. Having a structured transition program in place is essential to reduce poor health consequences. A key strategy to optimize outcomes involves the use of transition readiness and associated factors assessment to implement the recognition of vulnerability and protective aspects, knowledge, and skills of these patients and their parents. Therefore, this study aims to provide a comprehensive framework of clinical and psychosocial aspects associated with the transition from pediatric to adult medical care of patients with epilepsy.

METHODS

Measures examining different aspects of transition readiness and associated clinical, socio-demographic, psychological, and emotional factors were administered to 13 patients with epilepsy (Mage = 22.92, SD = 6.56) with (n = 6) or without (n = 7) rare diseases, and a respective parent (Mage = 56.63, SD = 7.36).

RESULTS

patients showed fewer problems in tracking health issues, appointment keeping, and pharmacological adherence as well as low mood symptoms and moderate resiliency. Moreover, they referred to a low quality of sleep. Notably, parents of patients with rare diseases reported a lower quality of sleep as compared to the other group of parents.

CONCLUSIONS

Increasing awareness around transition readiness is essential to promote self-management skills of patients with epilepsy and their parents. Anticipating the period of transition could be beneficial, especially to prevent problematic sleep patterns and promote independence in health care management. Parents of patients with epilepsy and rare diseases should be monitored for their mental status which can affect patients' well-being.

A randomized controlled trial of a home-based computerized executive function intervention for children with cerebral palsy

Children with cerebral palsy (CP) often show executive function (EF) impairments that are key to quality of life. The aim of this study was to assess whether a home-based computerized intervention program improves executive functions (EFs) compared to usual care. Sixty participants (30 females) with CP (8-12 years old) were paired by age, sex, motor ability, and intelligence quotient score and then randomized to intervention and waitlist control groups. The intervention group received a 12-week home-based computerized EF intervention (5 days/week, 30 min/day, total dose 30 h). Core and higher-order EFs were assessed before, immediately after, and 9 months after completing the intervention. The intervention group performed better than the waitlist control group in the three core EFs (immediately and 9 months after the intervention): inhibitory control (F = 7.58, p = 0.13 and F = 7.85, p = 0.12), working memory (F = 8.34, p = 0.14 and F = 7.55, p = 0.13), and cognitive flexibility (F = 4.87, p = 0.09 and F = 4.19, p = 0.08). No differences were found between the groups in higher-order EFs or EF manifestations in daily life.

CONCLUSIONS

A home-based computerized EF intervention improved core EFs in children with CP, but further research is needed to identify strategies that allow the transfer of these improvements to everyday life.

TRIAL REGISTRATION

NCT04025749 retrospectively registered on 19 July 2019.

WHAT IS KNOWN

• One in two children with cerebral palsy has an intellectual impairment. Visual perception and executive functions are the most reported specific cognitive deficits. • The majority of interventions for cerebral palsy focus on motor impairments, but only a few randomized controlled trials have explored the effect of interventions on executive functions.

WHAT IS NEW

• A home-based computerized cognitive intervention can improve the core executive functions of children with cerebral palsy. • Short- and long-term effects on core executive functions have been found.

Improving the use of transition readiness measures in research and clinical care

Measurement of transition readiness is considered a crucial component of effective transition. It is included as one of the Six Core Elements of Transition in national transitional care guidelines. However, the current measures of transition readiness have not been found to correlate with either current or future health outcomes for youth. In addition, there are challenges in measuring transition readiness in youth with intellectual and developmental disabilities, who may not be expected to achieve skills and knowledge that are considered essential for transition in typically developing youth. These concerns make it difficult to know how best to use transition readiness measures in research and clinical care. This article highlights the appeal of measuring transition readiness in clinical and research contexts, the current barriers that prevent us from fully achieving those benefits, and potential strategies for bridging the gap. IMPACT: Transition readiness measures were developed as an attempt to identify those patients who were ready to successfully navigate the transition from pediatric to adult health care. Thus far, the measures that have been developed do not appear to be related to health outcomes such as disease control or timely attendance of the first adult appointment in adult care. We provide suggestions for how to address the current concerns with the available transition readiness measures.

Transition readiness and quality of life in emerging adult college students

OBJECTIVE

To examine the relative contribution of transition readiness (i.e., healthcare self-management) to health-related quality of life (HRQoL) among emerging adult (EA) college students without a chronic medical condition (CMC).Participants: College students (n = 2372; Mage = 19.32, SD = 1.26) from a Midwestern university.Methods: Participants completed online measures of demographics, HRQoL, and transition readiness.Results: Hierarchical regression analyses found transition readiness accounted an additional 3-4% of the variability in mental and physical HRQoL (p < .001), beyond demographic factors. 11.3% of EAs reported overall mastery of transition readiness, with navigating health insurance being the weakest area.Conclusions: Findings support the consensus that transition readiness is relevant to HRQoL for all EAs, including those without a CMC. EAs without a CMC demonstrate relatively weak transition readiness skills. Primary and university-based healthcare might consider programs supporting transition readiness and HRQoL among underresourced EAs.

Identifying the Distinct Profiles of Transition Readiness in Chinese Pediatric Cancer Survivors

BACKGROUND

Transition readiness is important for pediatric cancer survivors who need to move from pediatric to adult medical care. However, their transition readiness profiles merit further exploration.

OBJECTIVES

The aim of this study was to use a person-centered approach to identify transition readiness profiles of Chinese pediatric cancer survivors aged 12 to 18 years, diagnosed at least 6 months before the study.

METHODS

Transition readiness was assessed using the Chinese TRANSITION-Q Scale, and latent class analysis was performed to identify the transition readiness profiles as well as demographic and clinical factors associated with profile classification and to examine how self-efficacy and quality of life may differ between these profiles.

RESULTS

A total of 139 pediatric cancer survivors were included. Three different transition readiness profiles were identified: high transition readiness, medium transition readiness, and low transition readiness. Age, treatment status, and parental working status were significantly associated with the transition readiness profile classifications. Those who were in the low transition readiness profile were likely to have lower self-efficacy and mobility scores than those in the high or medium transition readiness profiles.

CONCLUSIONS

Three distinct transition readiness profiles existed in a sample of Chinese pediatric cancer survivors, indicating significant heterogeneity in their transition readiness.

IMPLICATIONS FOR PRACTICE

Knowledge of transition readiness profiles can assist clinicians in screening pediatric cancer survivors for their profile memberships and provide targeted interventions for those with a low transition profile.

Quality of Life in Adolescents and Young Adults With a Chronic Medical Condition: The Role of Perceived Maturity and Transition Readiness

INTRODUCTION

Adolescents and young adults (AYA) with a chronic medical condition (CMC) attending college must learn to manage their own healthcare (i.e., transition readiness). Maturity has been linked to positive outcomes in AYAs. Research has established a positive relationship between transition readiness and quality of life. The current study aimed to examine a model of perceived maturityàtransition readinessàmental and physical quality of life.

METHOD

AYA (N = 153) with a CMC completed self-report questionnaires.

RESULTS

The perceived maturity→transition readiness→mental quality of life indirect path was significant (ab = 1.96, 95% CI = 0.53 to 3.62). The perceived maturity→transition readiness→physical quality of life direct and indirect paths were not significant.

DISCUSSION

Results showed that maturity and transition readiness are positively associated. Transition readiness may be one mechanism by which maturity results in enhanced quality of life.

PRACTICE IMPLICATIONS

Findings highlight the value of enhancing strengths such as maturity to promote AYA independence/autonomy.

Translation and validation of the STARx questionnaire in transitioning Chinese adolescents and young adults with chronic health conditions

BACKGROUND

Adolescent/young adults (AYAs) with chronic conditions must undergo healthcare transition (HCT) preparation until their mid-twenties. Valid HCT readiness measures are lacking in China.

METHODS

The present study translated, back-translated, and adapted the Self-Management and Transition to Adulthood with Rx = Treatment (STAR_x) Questionnaire. We examined the psychometric properties of this tool in a relatively large in-patient sample of AYAs with various chronic health conditions at a Chinese tertiary general hospital.

RESULTS

We enrolled 624 AYAs aged 10-25 years (19.66 ± 3.64) with various chronic health conditions. The Chinese version of the STAR_x Questionnaire demonstrated excellent internal consistency (Cronbach's alpha = 0.83) and reliability with a two-week test-retest (ICC = 0.88, p < .001). Furthermore, the Chinese version revealed a three-factor structure (self-management, disease knowledge, and provider communication) consistent with the revised English version of the STAR_x Questionnaire. In terms of discriminant validity, the total score of the Chinese STAR_x Questionnaire showed a significant positive correlation with age but no gender differences were found. In terms of predictive validity, the Chinese STAR_x Questionnaire was significantly correlated with shorter length of hospitalization and higher frequency of emergency room visit, but the correlations became insignificant after controlling for age.

CONCLUSIONS

The results suggest that the Chinese version of the STAR_x Questionnaire is a robust HCT readiness tool in AYAs with chronic conditions and clinicians may find it useful to develop individualized interventions.

Association between transition readiness and mental health comorbidity in youth with chronic health conditions

PURPOSE

Between 33 and 59% of youth with chronic health conditions experience mental health conditions. Transition readiness, or the acquisition of knowledge and self-management skills, facilitates successful transition to adult care. Transition readiness among youth with co-occurring chronic health and mental health conditions has not been explored.

DESIGN AND METHODS

This study used a sample of 201 patients (aged 16-21) with chronic conditions. All patients completed the Transition Readiness Assessment Questionniare (TRAQ) and were grouped into Cohort A: chronic health conditions only (n = 140), and Cohort B: co-occurring chronic health and mental health conditions (n = 61). A quantile regression at the 50th percentile was conducted to examine associations between TRAQ score and mental health comorbidity, age, gender and immigration status.

RESULTS

The median TRAQ score for Cohort A was 3.87 (IQR 0.84) versus 4.00 (IQR 0.87) for Cohort B. Our analysis revealed that having a mental health comorbidity (b = 0.402, p = 0.034), being older in age (b = 0.540, p = 0.004) and being female (b = 0.388, p = 0.001) were associated with higher overall TRAQ score.

CONCLUSIONS

The presence of a mental health comorbidity was associated with greater transition readiness as measured by the TRAQ in our sample. Future research should explore why youth with co-occurring chronic health and mental health conditions exhibit greater transition readiness.

PRACTICE IMPLICATIONS

Youth with co-occurring chronic health and mental health conditions may develop transition readiness as a result of coping with mental health challenges. Practitioners could invite them to reflect on how their physical and mental health are related and affect their level of preparedness for adult care.

The roles of quality of life and family and peer support in feelings about transition to adult care in adolescents with gastroenterology, renal, and rheumatology diseases

PURPOSE

Transition to adult healthcare is a critical time in the lives of adolescents with chronic medical conditions, with clear impacts on health outcomes. Little is known about factors that impact feelings about healthcare transition, including HRQOL, family and peer support, and utilization of a framework such as the SMART Model can guide exploration of these factors. The goal of this study is to examine how HRQOL (i.e., functional impact of disease) and family and peer support may impact adolescents' feelings about healthcare transition.

DESIGN AND METHODS

135 adolescents (17-23 years) with chronic gastroenterology, renal, or rheumatology disease completed four questionnaires as part of a larger study examining health, relationships, and healthcare transition. Questions assessed current HRQOL (i.e., number of days health was "not good"), peer and family support, and feelings about transition. Data were analyzed using SPSSv25 and linear regressions were performed.

RESULTS

Lower HRQOL (β = 0.283, p < .01) and less peer support (β = -0.198, p < .05) were associated with worse feelings about transition (R² = 0.203, p < .001). Family support was significantly correlated at the bivariate level. There were no differences by type of disease, race/ethnicity, or gender that impacted study findings.

CONCLUSION(S)

Results are concerning as healthcare transition is a milestone for every patient. Lower HRQOL (i.e., greater functional impact of disease) and less peer support were associated with worse feelings about transition.

PRACTICE IMPLICATIONS

This study highlights potential targets for intervention such as improving HRQOL (e.g., acceptance and commitment therapy) and increasing peer support (e.g., social skills training, family facilitation) to improve transition to adult care for pediatric patients with chronic diseases.

The Role of Avoidance Coping and Illness Uncertainty in the Relationship Between Transition Readiness and Health Anxiety

PURPOSE

The transition to college is associated with numerous stressors, including environmental changes, increased academic expectations, and changes in social support, all of which may be exacerbated by the added responsibility of managing a chronic medical condition. Huang (2019) proposed a model examining the relationships between coping styles, transition readiness, and health anxiety, and suggested that greater transition readiness is associated with adaptive coping strategies and less health anxiety. However, there are limited findings as to how poor transition readiness relates to health anxiety. Therefore, the current study tested a serial mediation model (i.e., poor transition readiness → avoidance coping → illness uncertainty → health anxiety).

DESIGN AND METHODS

College students (N = 194) with a chronic medical condition completed self-report questionnaires.

RESULTS

Results indicated several direct effects among the modeled variables and a significant poor transition readiness → avoidance coping → illness uncertainty → health anxiety serial mediation (path a₁d₂₁b₂ = 0.438, 95% CI = 0.153 to 0.913).

CONCLUSIONS

Worse transition readiness was associated with increased avoidance as a coping mechanism, which in turn is associated with increased illness uncertainty, and ultimately health anxiety. The current findings identified possible drivers of health anxiety in college students with a chronic medical condition.

PRACTICE IMPLICATIONS

These findings highlight that good transition readiness skills may buffer against maladaptive avoidance, illness uncertainty, and health anxiety. Modules aimed at improving healthcare management, avoidance, and illness uncertainty may be beneficial additions to interventions to reduce health anxiety.