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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.

Journal article
Authors Sandra Skogby
Philip Moons
Bengt Johansson
Jan Sunnegårdh
Christina Christersson
Edit Nagy
Per Winberg
Katarina Hanséus
Aleksandra Trzebiatowska-Krzynska
Shalan Fadl
Eva Fernlund
Kalliopi Kazamia
Annika Rydberg
Liesl Zühlke
Eva Goossens
Ewa-Lena Bratt
Published in International journal of cardiology
ISSN 1874-1754
Publication year 2020
Published at Institute of Health and Care Sciences
Language en
Links dx.doi.org/10.1016/j.ijcard.2020.01...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Paediatric cardiology, Epidemiology

Abstract

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. 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. 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. Our findings support the theory of hospital-related factors influencing continuity of care, above and beyond patient-related characteristics.

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