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Processes and Predictors in the Transition From Pediatric to Adult Epilepsy Care: A Retrospective Study at a Single
Jasmine Sondhi1, Esraa Ali1, Krishna Trivedi1
1UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
Documented transition discussions may improve transfer to adult care for epilepsy patients. Formal programs are recommended to optimize care for adolescents and young adults with epilepsy.
Area of Science:
- Neurology
- Healthcare Management
- Patient Care Transition
Background:
- Adolescents and young adults with epilepsy require careful management during care transitions.
- A lack of formal transition programs can hinder effective transfer from pediatric to adult care settings.
- Understanding current transition processes is crucial for identifying areas for improvement.
Purpose of the Study:
- To characterize the existing transition of care processes for epilepsy patients at an institution lacking a formal program.
- To identify factors influencing transition discussions, transfer to adult care, and retention in adult care.
Main Methods:
- Retrospective review of medical records for epilepsy patients aged 15+ from 2019-2022.
- Evaluation of documented transition discussions, transfer status, and retention in adult care.
- Logistic regression analysis to identify predictors of transition discussion, transfer, and retention.
Main Results:
- 25% of eligible patients had documented transition discussions; 51% transferred to adult care.
- Older age, documented transition discussion, and drug-resistant epilepsy (DRE) predicted transfer.
- Older age and absence of intellectual disability (ID) predicted transition discussion; no predictors for retention were found.
Conclusions:
- Transition discussions appear to facilitate transfer to adult care for epilepsy patients.
- The findings suggest a need for formal epilepsy transition of care programs to optimize patient outcomes.
- Implementing structured programs can improve the continuity and quality of care for this population.
Objective:
To characterize transition of care processes for patients with epilepsy in a single institution without a formal epilepsy transition of care program.
Methods:
We reviewed medical records for individuals with epilepsy who were at least 15 years old seen outpatient by pediatric neurology in 2019. We followed their records through 2022. We evaluated whether they had documentation of transition discussion, if they transferred to adult care, and/or if they were retained in adult care. Excluding individuals who died or were discharged, we performed logistic regression for transition discussion, transfer, and retention, adjusting for sex, age, race/ethnicity, distance from institution, zip code median household income, rurality, drug-resistant epilepsy (DRE), intellectual disability (ID), and technology dependence.
Results:
We evaluated documentation for 274 individuals (50% female, median age 18 years, 84% white, 1.5% Hispanic, 24% DRE, 25% ID). Excluding 14 who died and 28 who were discharged, 57 of 226 (25%) had a documented transition discussion and 115 (51%) transitioned (median age 20 years). Of 95 eligible individuals, 77 (81%) were retained in adult care. Predictors of transition discussion included older age (aOR: 1.44, 95% confidence interval: 1.22, 1.70) and absence of ID (aOR: 4.17 [1.51, 11.11]). Predictors of transfer included older age (aOR: 1.19 [1.02, 1.39]), documented transition discussion (aOR: 3.25 [1.48, 7.13]), and DRE (aOR: 2.41 [1.10, 5.28]). We identified no significant predictors of retention.
Conclusions:
Discussion of transition may promote transfer to adult care among people with epilepsy. Formal transition programs may be needed to optimize care processes.
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