Objective: Every year 500,000 youths in the U.S. with chronic disease need transfer to adult providers. Diabetes is a model of chronic illness that transcends age. For those with type 1 diabetes (T1D), 58% report a bad transition experience, the majority change adult providers and there is a 21% drop in clinic visits. Retrospective studies show unstructured transfers result in worse A1c. Despite the need, there is a lack of evidence-based interventions on the organization of care. Meta-analysis established engagement and retention in adult care as appropriate outcomes. Sustained continuity of care improves patient satisfaction and reduces hospital visits. We hypothesized that a physician trained in both adult and pediatric endocrinology would have greater show rates for patients transferred to adult care if he or she first provides care to the patient in the pediatric clinic. In this “guided transition” the doctor continues caring for the patient from pediatric to adult clinic.
Methods: We conducted a prospective cohort study of patients with T1D, age 16-26 years, referred to adult T1D clinic and seen by a physician trained in adult and pediatric endocrinology. Patients were grouped based on if their referral originated from another pediatric endocrinologist or if the dual-trained physician previously saw the patient in the pediatric T1D clinic. Transfer to adult care occurred when physician and patient felt it appropriate. The primary outcome was show rate at the first and second adult visits.
Results: Of 22 patients, 9 were referred from a different pediatric endocrinologist and 13 underwent guided transition. Both groups had similar initial A1c (p = 0.54). For patients seeing a different pediatric provider, the show rate to the first and second visit was 44% compared to 100% in the guided transition group (p = 0.003). The guided transition group maintained A1c (p = 0.79).
Conclusions: The guided transition group was significantly more likely to attend adult clinic than those seeing the provider for the first time. These findings deserve broader replication.
R. Lal: Consultant; Self; Abbott. D.M. Maahs: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Abbott, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. C. Dosiou: None. T. Aye: None. M. Basina: None.
National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007217)