A129 A SYSTEMATIC REVIEW ON MODELS OF CARE IN PEDIATRIC TO ADULT TRANSITION OF CARE
Bibliographic record
Abstract
In Canada, the transition from pediatric to adult care occurs between the ages of 12 and 25, with transfer of care occurring at 18. While there is limited literature pertaining to IBD-specific pediatric-to-adult care transition, the needs of pediatric IBD patients are not dissimilar to the needs of pediatric patients with other chronic diseases transitioning to adult care, and so learnings may be translatable across disease types. The objective of this systematic review was to evaluate pediatric-to-adult transitional models of care for all pediatric onset chronic diseases. We searched MEDLINE, EMBASE, PubMed, CINAHL, Cochrane and CENTRAL for prospective cohort studies published up to June 28, 2018. Title and abstract screening was performed by a single revewer. Articles meeting eligibility criteria then underwent full-text screening by two independent reviewers. Disagreements were adjudicated by the supervising author. The initial search yielded 10,499 articles. After title and abstract screening, 305 articles were obtained. 31 citations were included in this review after deduplication and full-text review, These studies evaluated transitional models of care in 11 different pediatric onset chronic diseases (type 1 diabetes (n=9), juvenile idiopathic arthritis (n=4), cystic fibrosis (n=3), inflammatory bowel disease (n=3), spina bifida (n=2), congenital heart disease (n=2), chronic kidney disease (n=1), congenital adrenal hyperplasia (n=1), sickle cell disease (n=1), HIV (n=1), esophageal atresia (n=1), mix of complex chronic disease (n=1), blood disorders (n=2). Models of care studied included transition clinics involving single or multiple appointments and/or multidisciplinary teams; transition program facilitators (registered nurse or social worker); and remote transition programs, including self-management online education modules and telephone coaching. Metrics for evaluation ranged from disease-specific outcomes (e.g. glycemic control) to self-reported outcomes (transition readiness, quality of life, compliance, etc.) and compliance with care post-transfer (e.g. proportion of patients who completed first appointment with adult specialist). Despite the heterogeneity in disease types, most studies focused on the implementation of a standardized multidisciplinary transition process that emphasized care coordination. However, there was little consensus on the metrics for evaluation, making the comparison of different models challenging. Models of transition from pediatric to adult care focusing on care coordination through a multi-disciplinary approach have been shown to improve patient outcomes. Future efforts are needed to establish standardized evaluation metrics improving ease of discrimination between models and potential comparison across disease types. Department of Medicine, Women’s College Hospital
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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 | 0.017 | 0.074 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.010 |
| Bibliometrics | 0.014 | 0.020 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.006 | 0.005 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 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".