Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;17(6):191-198.
doi: 10.5489/cuaj.8247.

Healthcare utilization during transition to adult care in patients with spina bifida A population-based, longitudinal study in Ontario, Canada

Rano Matta  1   2 , Christopher J D Wallis  1   3 , Jacob Etches  4 , Refik Saskin  4   5 , Armando J Lorenzo  1   6 , Humberto R Vigil  1   7 , Ronald T Kodama  1   2 , Sidney Radomski  1 , Robert K Nam  1   2   4 , Lesley Carr  1   2 , Sender Herschorn  1   2
Affiliations

Healthcare utilization during transition to adult care in patients with spina bifida A population-based, longitudinal study in Ontario, Canada

Rano Matta et al. Can Urol Assoc J. 2023 Jun.

Abstract

Introduction: Individuals with spina bifida (SB) may experience negative health outcomes because of an informal transition from pediatric to adult care that results in using the emergency room (ER ) for non-acute health problems.

Methods: We conducted a retrospective, population-based cohort study of all people with SB in Ontario, Canada turning 18 years old between 2002 and 2011. These patients were followed for five years before and after age 18. Primary outcome was the annual rate of ER visits. Secondary outcomes included rates of hospitalization, surgery, primary care, and specialist outpatient care. We estimated the association between age and primary and secondary outcomes using negative binomial growth curve models, adjusting for patient-level baseline covariates.

Results: Among the 1215 individuals with SB, there was no trend of ER visits seen with increasing age (relative risk [RR ] 0.99, 95% confidence interval [CI] 0.98-1.02); however, there was a significant increase in the rate of ER visits associated with turning 18 years (RR 1.14, 95% CI 1.03-1.27). Turning 18 years old was also associated with a decreased rate of hospital admissions (RR 0.79, 95% CI 0.66-0.95) and no change in surgeries (RR 0.80, 95% CI 0.64-1.02). Visits to primary care physicians remained stable over the same period (RR 0.96, 95% CI 0.90-1.01), while visits to SB-focused specialists decreased after age 18 (RR 0.81, 95% CI 0.75-0.87).

Conclusions: In patients with SB, the rate of ER visits increased significantly at 18 years old, while hospital admissions and specialist physician visits decreased at the same time. Models of transitional care can aim to reduce non-urgent ER visits and facilitate regular specialist care.

PubMed Disclaimer

Conflict of interest statement

COMPETING INTERESTS: Dr. Herschorn has received a clinical trial grant from Urovant; has served on advisory boards for AbbVie and Boston Scientific; and received support for meeting attendance/travel from AbbVie and Pfizer. The remaining authors do not report any competing personal or financial interests related to this work.

Figures

Figure 1
Figure 1
Study flow diagram of inclusion and exclusion criteria. OHIP Ontario Health Insurance Plan. *Exact numbers are suppressed when cell counts are ≤5 or can be back calculated, to protect patient confidentiality.
Figure 2
Figure 2
Annual rate of (A) inpatient service volumes and (B) outpatient service volumes for patients with SB between ages 13 years and 22 years old.
See this image and copyright information in PMC

References

    1. Dicianno BE, Wilson R. Hospitalizations of adults with spina bifida and congenital spinal cord anomalies. Arch Phys Med Rehabil. 2010;91:529–35. doi: 10.1016/j.apmr.2009.11.023. - DOI - PMC - PubMed
    1. Le JT, Mukherjee S. Transition to adult care for patients with spina bifida. Phys Med Rehabil Clin N Am. 2015;26:29–38. doi: 10.1016/j.pmr.2014.09.007. - DOI - PubMed
    1. Hsieh MH, Wood HM, Dicianno BE, et al. Research needs for effective transition in lifelong care of congenital genitourinary conditions: A workshop sponsored by the national institute of diabetes and digestive and kidney diseases. Urology. 2017;103:261–71. doi: 10.1016/j.urology.2016.12.052. - DOI - PMC - PubMed
    1. Timberlake MD, Corbett ST, Costabile RA, et al. Identification of adolescent and adult patients receiving pediatric urologic care and establishment of a dedicated transition clinic. J Pediatr Urol. 2015;11:62e1–6. doi: 10.1016/j.jpurol.2014.11.013. - DOI - PubMed
    1. Stephany HA, Ching CB, Kaufman MR, et al. Transition of urologic patients from pediatric to adult care: a preliminary assessment of readiness in spina bifida patients. Urology. 2015;85:959–63. doi: 10.1016/j.urology.2014.12.019. - DOI - PubMed

LinkOut - more resources