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

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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.
International Journal of Cardiology ( IF 3.2 ) Pub Date : 2020-01-17 , DOI: 10.1016/j.ijcard.2020.01.016
Sandra Skogby ₁ , Philip Moons ₂ , Bengt Johansson ₃ , Jan Sunnegårdh ₄ , Christina Christersson ₅ , Edit Nagy ₆ , Per Winberg ₇ , Katarina Hanséus ₈ , Aleksandra Trzebiatowska-Krzynska ₉ , Shalan Fadl ₁₀ , Eva Fernlund ₁₁ , Kalliopi Kazamia ₁₂ , Annika Rydberg ₁₃ , Liesl Zühlke ₁₄ , Eva Goossens ₁₅ , Ewa-Lena Bratt ₁₆

Affiliation

Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Gothenburg, Sweden; Department of Paediatric Cardiology, Queen Silvia's Children's Hospital, Rondvägen 10, 416 50 Gothenburg, Sweden; KU Leuven Department of Public Health and Primary Care, Kapucijnenvoer 35, PB 7001, 3000 Leuven, Belgium.
Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Gothenburg, Sweden; KU Leuven Department of Public Health and Primary Care, Kapucijnenvoer 35, PB 7001, 3000 Leuven, Belgium; Department of Paediatrics and Child Health, University of Cape Town, Klipfrontein Road Mowbray, Cape Town 7700, South Africa.
Department of Public Health and Clinical Medicine, Umeå University, 90185 Umeå, Sweden.
Department of Paediatric Cardiology, Queen Silvia's Children's Hospital, Rondvägen 10, 416 50 Gothenburg, Sweden.
Department of Medical Sciences, Cardiology, Uppsala University, Sjukhusvägen 7, 753 09 Uppsala, Sweden.
Heart and Vascular Theme, Congenital Heart Disease Group, Karolinska University Hospital, Stockholm, 171 76 Solna, Sweden.
Department of Paediatric Cardiology, Karolinska University Hospital, Eugeniavägen 23 C8:34, 17176 Stockholm, Sweden.
Department of Paediatric Cardiology, Skåne University Hospital, Barnhjärtcentrum avd 67, 221 85 Lund, Sweden.
Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Sjukhusvägen, 581 85 Linköping, Sweden; Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Sjukhusvägen, 58185 Linköping, Sweden.
Department of Paediatric and Women's Health Care, Örebro University Hospital, 701 85 Örebro, Sweden.
Department of Clinical and Experimental Medicine, Division of Paediatrics, Crown Princess Victoria Children's Hospital, Linköping University, 581 85 Linköping, Sweden; Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Department of Paediatric Cardiology, 221 85 Lund, Sweden.
Department of Paediatric Cardiology, Uppsala University, Sjukhusvägen 85, 75185 Uppsala, Sweden.
Department of Clinical Sciences, Unit of Paediatrics, Umeå University, Umeå University Hospital, 90185 Umeå, Sweden.
Division of Paediatric Cardiology, Department of Paediatric and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, Klipfrontein Road Mowbray, Cape Town 7700, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Anzio Road Mowbray, Cape Town 7700, South Africa.
KU Leuven Department of Public Health and Primary Care, Kapucijnenvoer 35, PB 7001, 3000 Leuven, Belgium; Research Foundation Flanders (FWO), Egmontstraat 5, 1030 Brussels, Belgium.
Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Gothenburg, Sweden; Department of Paediatric Cardiology, Queen Silvia's Children's Hospital, Rondvägen 10, 416 50 Gothenburg, Sweden.

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.

中文翻译：

门诊病人数量和医务人员资源是先天性心脏病青少年转移期间随访服务连续性的预测指标。

背景技术在许多情况下，向患有先天性心脏病（CHD）的患者提供连续的随访护理仍然是一个挑战。先前的研究强调患有冠心病的患者会中断后续治疗，但主要描述的是单中心观点，忽略了机构间差异。人们认为，超出患者相关因素的医院相关因素会影响护理的连续性。因此，目前的多中心研究调查了（i）“无后续护理”的比例；（ii）离开小儿心脏病学后的目的地；（iii）各中心之间没有后续行动的比例有所不同；（iv）无随访量和门诊量之间的关联，以及（v）与门诊人员资源的关系。方法观察性在七所大学医院进行了多中心研究。总的来说，包括1991年至1993年之间出生的654名患有CHD的青少年，其门诊时间为14-18岁。根据医疗档案，自我报告和登记表，在计划转移至成人护理5年后（23y）确定转移状态。结果总体上，有89.7％的患者在转移后接受成人随访护理。6.6％没有随访；和3.7％是无法追踪的。在接受后续治疗的患者中，只有一名仍留在儿科护理中，大多数接受了成人CHD专科护理。各个中心之间没有随访的比例存在显着差异。儿科门诊门诊量增加与转移后更好的持续随访护理相关（OR = 1.061； 95％CI = 1.001-1.124）。医务人员配置资源无法预测。结论我们的发现支持了影响患者连续性的医院相关因素的理论，超出了患者相关特征。

更新日期：2020-01-17

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