1. The risk for avoidable hospitalizations, a marker for access to and quality of ambulatory management of disease, increased after young patients with end stage renal disease (ESRD) transitioned from pediatric to adult care.
2. Among young patients who always received their ESRD treatment at adult facilities, the risk of avoidable hospitalizations increased with age.
Evidence Rating Level: 2 (Good)
Study Rundown: Prior studies have shown that adolescents with end stage renal disease (ESRD) have poorer clinic attendance and medication compliance than younger children. This study sought to examine how adolescence and the transition from pediatric to adult care correlate with rates of avoidable hospitalizations as a surrogate for illness burden and access to care. Avoidable hospitalizations are defined as hospitalizations for conditions that could have been prevented given adequate primary and specialty ambulatory care. The current study gathered information on hospitalizations of adolescents and young adults with ESRD. Results indicate that, among patients who transferred care from a pediatric to adult clinic setting, there was an increased rate in avoidable subsequent hospitalizations. Among those that only had care in adult facilities, there was a greater proportion of avoidable hospitalizations in older age groups. One major limitation is that the scheme used to define avoidable hospitalizations had not been tested before. These findings suggest that this transition period is one of poorer preventative care practices for patients with ESRD and has the potential to drastically impact long term outcomes. Physicians could impact this through intentional transitional practices, although further studies need to be done to show the effectiveness of these transitional models.
In-Depth [retrospective cohort study]: This retrospective cohort study examined 349 patients under age 22 who initiated adult ESRD care after age 15 between 2001 and 2010, as monitored by the Canadian Organ Replacement Register (CORR). The study excluded patients with multiple organ transplants and those without a logical progression from pediatric to adult care. The rate of avoidable hospitalizations was adjusted for potential confounders, including age at ESRD onset, gender, socioeconomic status, etiology of ESRD, ethnicity, and distance to the nearest pediatric renal care center. There was a three-fold increase in the rate of avoidable hospitalizations in the three- to less than four-year period after transfer of care from pediatric to adult facilities (rate ratio 3.19 [95% CI: 1.42-7.18]). Among patients receiving their care only at adult facilities, there was an increase in avoidable hospitalization rates with increasing age: the 19 to <21, 21 to <23, and 23 to <25 year-old groups had significantly higher rates than the 15 to <19 group (adjusted risk ratio = 1.94, 2.22 and 2.67 respectively).
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