Impact of the Transition from Pediatric to Adult Medical Care on Health Service Utilization in Inflammatory Bowel Disease (IBD)
Bibliographic record
Abstract
OBJECTIVES: Inflammatory bowel disease (IBD) is a chronic condition with increasing pediatric incidence. Transition from pediatric to adult care is associated both with disruption of links with familiar caregivers and differences in health care delivery. This study explored the impact of the transfer from pediatric to adult care on health services utilization for pediatric-onset IBD patients. APPROACH: A population-based retrospective cohort study identified all children diagnosed with IBD 1994-2008 and treated by pediatric gastroenterologists from within Ontario health administrative data. Self-controlled case series analyses compared health services utilization in the 2 years before and after transfer to adult gastroenterologists, with a 6-month washout period at transfer. Outcome evaluated included IBD related/specific hospitalization, emergency department (ED) utilization, outpatient visits, and laboratory utilization. Relative incidence (RI) in the post-transfer was compared to pre-transfer periods using Poisson regression analysis controlling for transfer starting age. Analyses were stratified by IBD types: Crohn’s disease (CD) and ulcerative colitis (UC). RESULTS: 536 patients were included in the study (388 CD, 148 UC). ED utilization rate was higher after transfer for both CD (RI 2.12, 95% CI 1.53-2.93) and UC (RI 2.34, 95% CI 1.09-5.03). Other increases in health care provision included outpatients visits (CD: RI 1.56, 95% CI 1.42-1.72; UC: RI 1.48, 95% CI 1.24-1.76), and laboratory investigations (CD: RI 1.43, 95% CI 1.26-1.63; UC: 1.38, 95% CI 1.13-1.68). There was no statistically significant change in hospitalization (CD: RI 0.70, 95% CI 0.42-1.18; UC: RI 2.41, 95% CI 0.62-9.40). Sensitivity analysis revealed similar results when only the first year post-transfer period was assessed. CONCLUSIONS: In the largest study to date examining the transfer from pediatric to adult IBD care, health services utilization increased significantly in the two years after transfer for measures of access to health care providers. Understanding causation and rigorously evaluated transition programs may help to better manage the resources and meet the needs of pediatric-onset IBD patients.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".