Pediatric Orthopaedic Providers' Views on Transition From Pediatric to Adult Care
Laurie N Fishman1, Rachel DiFazio, Patricia Miller
1*Division of Gastroenterology, Hepatology and Nutrition †Department of Orthopedics, Boston Children's Hospital, Boston, MA.
Insights
Pediatric orthopaedic providers often care for adult patients, facing barriers like lack of adult specialists. Guidelines are needed to improve patient transition to adult care.
Area of Science:
- Orthopaedic Surgery
- Pediatric Care
- Adult Transition Medicine
Background:
- Surgical specialties, particularly orthopaedics, are underrepresented in discussions about transitioning pediatric patients to adult care.
- This study addresses the pediatric orthopaedic perspective on managing patients into adulthood, including age cutoffs, transfer triggers, and barriers.
- Provider demographics were analyzed for their influence on these perspectives.
Purpose of the Study:
- To understand the pediatric orthopaedic perspective on long-term patient care into adulthood.
- To identify common conditions managed, age thresholds for transfer, and triggers/barriers to transition.
- To examine how provider demographics impact views on adult patient care.
Main Methods:
- An anonymous internet-based survey was distributed to members of the Pediatric Orthopaedic Society of North America and the Pediatric Orthopaedic Practitioner Society.
- Voluntary responses were collected to gather data on current practices and challenges.
- The study design was Level III-survey research.
Main Results:
- A significant portion of respondents (70%) care for patients over 25, with many (35%) seeing patients over 40, primarily for neuromuscular and congenital disorders.
- Providers in salaried models and free-standing children's hospitals reported caring for fewer adult patients compared to others.
- Key transfer triggers included adult comorbidities and institutional policy, while lack of qualified adult providers and ongoing surgical issues were major barriers.
Conclusions:
- Pediatric orthopaedic providers frequently manage older patients, often relying on external factors for transfer decisions.
- Financial models and institutional policies appear to influence the care of adult patients.
- National society guidelines could help standardize care and address variations in managing patients transitioning to adult services.
Background:
Surgical specialties are underrepresented in the discussions regarding transition and transfer of patients to adult care. We sought the pediatric orthopaedic perspective on types of patients seen into adulthood, age cut-offs, triggers for transfer, and barriers to transition. We examined provider demographic factors that may influence perspectives.
Methods:
An internet-based survey was sent to all members of the Pediatric Orthopaedic Society of North America and the Pediatric Orthopaedic Practitioner Society. Responses were voluntary and anonymous.
Results:
Response rates were 27% for the Pediatric Orthopaedic Society of North America and 24% for the Pediatric Orthopaedic Practitioner Society. Most respondents (70%) care for patients over the age of 25 years and many (35%) for patients over the age of 40. The most common conditions cared for were neuromuscular and congenital disorders. Respondents who worked in a fully salaried model reported caring for fewer of these adult patients compared with those working in other types of payment structure (P<0.001). Respondents working in free-standing children's hospitals reported fewer patients over 30 years old compared with nonchildren's hospital settings (P<0.001). There were no significant differences between profit-based and nonprofit settings. The top triggers for transfer to adult providers were: (1) adult comorbidities; (2) transition to medical specialist; and (3) institutional policy. The top barriers to transfer were: (1) lack of qualified adult providers; (2) institutional policy; and (3) on-going surgical issues.
Conclusions:
Many providers care for older patients, often using external triggers for transfer to adult care. Financial considerations may need to be further explored. Variation in care may be aided by national society guidelines.
Level Of Evidence:
Level III-survey research.
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