Transition of Pediatric Patients to Adult Sickle Cell Care
Location
Medical Education Building, LSUHSC-NO
Presentation Date
10-10-2019 10:00 AM
End Date
10-10-2019 12:00 PM
Description
Introduction: Sickle cell disease (SCD) is an inherited blood disorder characterized by intermittent vaso-occlusive crises (VOCs) and chronic hemolytic anemia. SCD patients may utilize emergency department (ED) and inpatient hospital services when they are unable to manage their SCD complications at home. About 75,000 hospitalizations due to SCD occurred in the US each year from 1989-1993, costing about $475 million annually. A pediatric hematology/oncology clinic in southeastern Louisiana created a transition program for its SCD patients, aiming to improve management of SCD in patients as they transition from pediatric to adult care. This purpose of this study is to evaluate the efficacy of this transition program on the outcomes of patients with SCD, measured by ED and hospital use, number of VOCs, and completion of routine SCD visits.
Methods: This study is a retrospective chart review of SCD patients who were treated at both the pediatric and adult hematology/oncology clinics at a southeastern Louisiana medical center between 2014-present. Data were abstracted from patients’ charts into a REDCap database. Data abstracted included demographics, clinic visits, ED visits, adult infusion visits, and hospitalizations. Data were compared between patients who did and did not complete the transition program and were analyzed using the Mann Whitney U test for significance. Data are reported as median due to non-normal distributions.
Results: A total of 47 patients were included in our study; 36 patients completed the transition program, and 11 patients did not. Patient demographics between the groups were similar, with no significant differences in gender, SCD genotype, insurance, history of VOCs, hydroxyurea use, and history of depression or anxiety. The time between final pediatric clinic visit and first adult clinic visit was significantly shorter in patients who completed the program compared to patients who did not (57 vs 327 days). Patients who completed the program also had fewer ED visits (normalized to year) in the time between pediatric and adult clinics (0 vs 2.27 visits per year). Following establishment of adult SCD care, there were no significant differences in ED visits for SCD complications (0 vs 0.40 per year) or VOCs (0.50 vs 1.17) between the two groups.
Conclusions: Our study suggests that patients who complete the transition program establish care in an adult setting sooner than patients who did not complete the program, perhaps reducing the need for these patients to utilize ED services during this time. It also suggests that patients who complete the program are better able to manage SCD on their own during the time between pediatric to adult care, when they are not being overseen by a hematology provider.
Recommended Citation
Anzalone, Fallon A., "Transition of Pediatric Patients to Adult Sickle Cell Care" (2019). Medical Student Research Poster Symposium. 2.
https://digitalscholar.lsuhsc.edu/sommrd/2019/posters/2
Transition of Pediatric Patients to Adult Sickle Cell Care
Medical Education Building, LSUHSC-NO
Introduction: Sickle cell disease (SCD) is an inherited blood disorder characterized by intermittent vaso-occlusive crises (VOCs) and chronic hemolytic anemia. SCD patients may utilize emergency department (ED) and inpatient hospital services when they are unable to manage their SCD complications at home. About 75,000 hospitalizations due to SCD occurred in the US each year from 1989-1993, costing about $475 million annually. A pediatric hematology/oncology clinic in southeastern Louisiana created a transition program for its SCD patients, aiming to improve management of SCD in patients as they transition from pediatric to adult care. This purpose of this study is to evaluate the efficacy of this transition program on the outcomes of patients with SCD, measured by ED and hospital use, number of VOCs, and completion of routine SCD visits.
Methods: This study is a retrospective chart review of SCD patients who were treated at both the pediatric and adult hematology/oncology clinics at a southeastern Louisiana medical center between 2014-present. Data were abstracted from patients’ charts into a REDCap database. Data abstracted included demographics, clinic visits, ED visits, adult infusion visits, and hospitalizations. Data were compared between patients who did and did not complete the transition program and were analyzed using the Mann Whitney U test for significance. Data are reported as median due to non-normal distributions.
Results: A total of 47 patients were included in our study; 36 patients completed the transition program, and 11 patients did not. Patient demographics between the groups were similar, with no significant differences in gender, SCD genotype, insurance, history of VOCs, hydroxyurea use, and history of depression or anxiety. The time between final pediatric clinic visit and first adult clinic visit was significantly shorter in patients who completed the program compared to patients who did not (57 vs 327 days). Patients who completed the program also had fewer ED visits (normalized to year) in the time between pediatric and adult clinics (0 vs 2.27 visits per year). Following establishment of adult SCD care, there were no significant differences in ED visits for SCD complications (0 vs 0.40 per year) or VOCs (0.50 vs 1.17) between the two groups.
Conclusions: Our study suggests that patients who complete the transition program establish care in an adult setting sooner than patients who did not complete the program, perhaps reducing the need for these patients to utilize ED services during this time. It also suggests that patients who complete the program are better able to manage SCD on their own during the time between pediatric to adult care, when they are not being overseen by a hematology provider.
Comments
Mentor: Katie Vance, PhD (Our Lady of the Lake Regional Medical Center)