DOI: 10.1136/bmjopen-2018-027045
The Calgary Transition Cohort provides a unique lens into the healthcare patterns of adolescents with chronic health conditions. It represents a crucial step towards understanding the health service utilisation of such individuals prior to their transition to adult care. The cohort consists of adolescents treated at a tertiary paediatric hospital in Alberta, Canada before a new intervention was introduced to improve transitions to adult care. Long-term follow-up and precise identification methodologies contribute to the value of this cohort in predicting the needs and challenges of healthcare transitions for young people, potentially impacting policies and practices.
Introduction
The transition from pediatric to adult-oriented healthcare is a critical progression for adolescents, yet it is fraught with challenges, particularly for those with chronic health conditions. The Calgary Transition Cohort study, based at a tertiary pediatric hospital in Alberta, Canada, was established to closely examine the patterns of health service use among adolescents as they move through this transition. This article will delve into the creation of the cohort, the methodology employed, its findings, and the implications for healthcare systems and policies.
Methodology and Cohort Identification
The study followed a stepwise identification process relying on hospital records and specially designed algorithms. Adolescents fitting a specific set of criteria—those who visited a hospital ambulatory chronic care clinic (CCC) at least four times within any 24-month window between 12 and 17 years old—were included in the cohort. A total of 1,344 eligible adolescents were identified (median age of 14 at entry, 22 at exit), with a median follow-up duration of 8.7 years (Schraeder et al., 2019).
The research team attained a 97% success rate in linking these individuals to their population-level health records, including physician claims, hospital admissions, and emergency room visits, all of which allowed for comprehensive data collection on the occurrence of chronic diseases (International Classification of Diseases, 9th/10th Revisions) during the entire study window.
Findings
A staggering 87.9% of the cohort had at least one encounter with a chronic disease code within the study period. This high percentage underscores the persistent healthcare needs of adolescents with chronic conditions and the necessity of smooth transitions to adult care services.
Discussion
The Calgary Transition Cohort provides a rich data source for analyzing the healthcare pathways and challenges that accompany adolescents with chronic health conditions. The study hopes to inform policies that will ensure continuous, coordinated, and comprehensive care during the pivotal transition to adult healthcare services. Given the complexities of managing chronic conditions during the developmental phase of adolescence, the insights gleaned here are invaluable for improving patient outcomes and the broader healthcare landscape.
Healthcare and Policy Implications
As the study sheds light on health service patterns, it also sparks critical conversations about the broader systemic and policy changes needed to support this vulnerable group. The demographic’s extensive healthcare needs stress the importance of transition programs that are not only supportive but also tailored to address individual conditions and circumstances.
The study also highlights the potential risk of lost follow-up during transition, a problem underscored by Mackie et al. (2009), who noted that a significant percentage of children and adults with congenital heart disease were lost to follow-up around the transition age.
Limitations and Further Research
While the Calgary Transition Cohort offers pivotal insights, it is also bound by certain limitations. It is retrospective and single-centered and may not capture all the complexities of healthcare transitions, which can vary widely based on geopolitical and health system factors. Future research should build on the groundwork laid by the Calgary Transition Cohort to include diverse regions and healthcare settings and consider the impact of sociodemographic factors on transition outcomes.
Conclusion
The creation and analysis of the Calgary Transition Cohort represent a significant step forward in understanding and improving the transition from pediatric to adult healthcare for adolescents with chronic conditions. Further research based on this cohort’s findings can lead to improved interventions and support systems, ultimately enhancing the quality of life for these individuals as they navigate their complex healthcare journeys.
References
1. Schraeder, K. K., Nettel-Aguirre, A., Mackie, A., et al. (2019). Identifying a retrospective cohort of adolescents with chronic health conditions from a paediatric hospital prior to transfer to adult care: the Calgary Transition Cohort. BMJ Open, 9(5), e027045.
2. Kaufman, M., & Pinzon, J. (2007). Transition to adult care for youth with special health care needs. Paediatr Child Health, 12(9), 785-788.
3. Nakhla, M., Daneman, D., To, T., et al. (2009). Transition to adult care for youths with diabetes mellitus: findings from a Universal Health Care System. Pediatrics, 124, e1134-e1141.
4. Gray, W. N., Holbrook, E., Morgan, P. J., et al. (2015). Transition readiness skills acquisition in adolescents and young adults with inflammatory bowel disease. Inflamm Bowel Dis, 21(5), 1125-1131.
5. Gurvitz, M. Z., Inkelas, M., Lee, M., et al. (2007). Changes in hospitalization patterns among patients with congenital heart disease during the transition from adolescence to adulthood. J Am Coll Cardiol, 49(6), 875-882.
Keywords
1. Calgary Transition Cohort
2. Chronic health conditions
3. Adolescent healthcare
4. Transition to adult care
5. Health service utilization