The impact of transition of Spina Bifida Care: A retrospective population-based cohort study comparing outcomes and health care costs longitudinally from adolescence into adulthood

Author:

Playfair Matthew1ORCID,McClure James Andrew2,Le Britney2,Cassidy Caitlin13,Wang Peter4,Welk Blayne245,Dave Sumit14

Affiliation:

1. Schulich School of Medicine and Dentistry, Western University , London, Ontario , Canada

2. ICES Western , London, Ontario , Canada

3. St. Joseph’s Health Care London, Parkwood Institute , London , Ontario , Canada

4. Division of Urology, Department of Surgery and Pediatrics, Children’s Hospital , London, Ontario , Canada

5. Department of Surgery and Epidemiology & Biostatistics, Western University , London, Ontario , Canada

Abstract

Abstract Introduction Transition from multidisciplinary paediatric to adult care results in a significant change in the intensity of care provided to patients with spina bifida (SB). Objective To compare planned and unplanned health care utilization and costs of care of transitioning SB patients. Study Design Through a retrospective population-based cohort study, patients with SB born in Ontario between 1988 and 1999 were studied using routinely collected data analysed at ICES. Patients were followed longitudinally from age 16 to 22 years with comparisons made between the paediatric baseline year (age 16) to the first 3 years of adulthood (ages 19 to 21). A composite primary outcome of unplanned emergency room (ER) visits, hospitalizations and emergency surgical procedures, was compared before and after transition. Secondary outcomes included these variables individually and estimated health care costs. Results In the 299 patients, no significant differences were identified in the composite primary outcome between periods (P = 0.09). Unplanned ER visits (P = 0.004) and emergency surgical procedures (P = 0.02) increased after transition. Despite this, the estimated individual total cost of care declined after transition (P = 0.03). Further, multivariable analysis identified rural residence (RR 1.78, confidence interval [CI] 1.30 to 2.44) and previous urologic surgery (RR 1.91, CI 1.41 to 2.57) as significant predictors of increased need for emergent care and health care costs, respectively. Conclusion Patients with SB in Ontario have higher rates of ER usage and unplanned surgery after the transition to adult care. While this does not drive an increase in health care costs, improvements in the care of transitioned SB patients, particularly rural patients and those with prior urologic surgery, may decrease the requirement for acute care.

Funder

Ontario Ministry of Health

Publisher

Oxford University Press (OUP)

Subject

Pediatrics, Perinatology and Child Health

Reference21 articles.

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