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Outpatient volumes and medical staffing resources as predictors for continuity of follow-up care during transfer of adolescents with congenital heart disease

Skogby, Sandra ; Moons, Philip ; Johansson, Bengt ; Sunnegårdh, Jan ; Christersson, Christina ; Nagy, Edit ; Winberg, Per ; Hanséus, Katarina LU ; Trzebiatowska-Krzynska, Aleksandra and Fadl, Shalan , et al. (2020) In International Journal of Cardiology
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... (More)

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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publication status
epub
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keywords
Adolescent, Continuity of patient care, Heart defects, congenital, Patient transfer, Transition to adult care, Young adult
in
International Journal of Cardiology
publisher
Elsevier
external identifiers
  • scopus:85077930713
  • pmid:31959410
ISSN
0167-5273
DOI
10.1016/j.ijcard.2020.01.016
language
English
LU publication?
yes
id
1af46b95-d125-4494-973c-0735cf9ce276
date added to LUP
2020-01-29 15:06:58
date last changed
2020-07-01 05:28:35
@article{1af46b95-d125-4494-973c-0735cf9ce276,
  abstract     = {<p>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.</p>},
  author       = {Skogby, Sandra and Moons, Philip and Johansson, Bengt and Sunnegårdh, Jan and Christersson, Christina and Nagy, Edit and Winberg, Per and Hanséus, Katarina and Trzebiatowska-Krzynska, Aleksandra and Fadl, Shalan and Fernlund, Eva and Kazamia, Kalliopi and Rydberg, Annika and Zühlke, Liesl and Goossens, Eva and Bratt, Ewa Lena},
  issn         = {0167-5273},
  language     = {eng},
  publisher    = {Elsevier},
  series       = {International Journal of Cardiology},
  title        = {Outpatient volumes and medical staffing resources as predictors for continuity of follow-up care during transfer of adolescents with congenital heart disease},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2020.01.016},
  doi          = {10.1016/j.ijcard.2020.01.016},
  year         = {2020},
}