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Challenges of intra-institutional transfer of care from paediatric to adult congenital cardiology: the need for retention as well as transition

Published online by Cambridge University Press:  13 April 2015

Claudine M. Bohun
Affiliation:
Division of Pediatric Cardiology, Oregon Health & Science University, Portland, Oregon, United states of America
Patricia Woods
Affiliation:
Adult Congenital Heart Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, United states of America
Christiane Winter
Affiliation:
Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon, United states of America
Julie Mitchell
Affiliation:
Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon, United states of America
Joel McLarry
Affiliation:
Adult Congenital Heart Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, United states of America
Joseph Weiss
Affiliation:
Adult Congenital Heart Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, United states of America
Craig S. Broberg*
Affiliation:
Adult Congenital Heart Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, United states of America
*
Correspondence to: C. Broberg, MD, UHN 62, Knight Cardiovascular Institute, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America. Tel: +503 494 7400; Fax: +503 494 8550; E-mail: brobergc@ohsu.edu

Abstract

Background

Transferring patients with CHD from paediatric to adult care has been challenging, especially across institutions. Within a single institution, some issues such as provider interaction, information exchange, or administrative directives should not play a significant role, and should favour successful transfer.

Objective

We studied patients who were eligible for transfer to the adult congenital heart disease service within our institution in order to identify factors associated with successful transfer to adult care providers versus failure to transfer.

Methods

Patients above18 years of age with CHD who were seen by paediatric cardiologists before January, 2008 were identified through a patient-care database. Records were reviewed to determine follow-up between 2008 and 2011 and to determine whether the patient was seen in the adult congenital cardiology clinic, paediatric cardiology clinic, or had no follow-up, and statistical comparisons were made between groups.

Results

After reviewing 916 records, 229 patients were considered eligible for transition to adult congenital cardiology. Of these, 77 (34%) were transferred successfully to adult congenital cardiology, 47 (21%) continued to be seen by paediatric cardiologists, and 105 (46%) were lost to follow-up. Those who transferred successfully differed with regard to complexity of diagnosis, insurance, and whether a formal referral was made by a paediatric care provider. Only a small fraction of the patients who were lost to follow-up could be contacted.

Conclusion

Within a single institution, with shared information systems, administrations, and care providers, successful transfer from paediatric to adult congenital cardiology was still poor. Efforts for successful retention are just as vital as those for transfer.

Type
Original Articles
Copyright
© Cambridge University Press 2015 

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