PD39-09 PATTERNS OF CARE AND OUTCOMES AROUND TRANSITION IN PATIENTS WITH SPINAL DYSRAPHISM: A POPULATION-BASED STUDY IN ONTARIO, CANADA
Bibliographic record
Abstract
You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Transitional Urology & GU Congenitalism (PD39)1 Apr 2019PD39-09 PATTERNS OF CARE AND OUTCOMES AROUND TRANSITION IN PATIENTS WITH SPINAL DYSRAPHISM: A POPULATION-BASED STUDY IN ONTARIO, CANADA Rano Matta*, Christopher J.D. Wallis, Humberto Vigil, Armando Lorenzo, Ronald T. Kodama, Robert K. Nam, Sidney B. Radomski, Lesley K. Carr, and Sender Herschorn Rano Matta*Rano Matta* More articles by this author , Christopher J.D. WallisChristopher J.D. Wallis More articles by this author , Humberto VigilHumberto Vigil More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , Ronald T. KodamaRonald T. Kodama More articles by this author , Robert K. NamRobert K. Nam More articles by this author , Sidney B. RadomskiSidney B. Radomski More articles by this author , Lesley K. CarrLesley K. Carr More articles by this author , and Sender HerschornSender Herschorn More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556412.78022.9fAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Patients with neuropathic bladder dysfunction associated with spina bifida are typically diagnosed and initially treated by pediatric specialists. Abrupt transition of care to adult practices, often at age 18, has been hypothesized to compromise patient care. However, we lack robust data to support this idea. We hypothesize that if patients lack adequate transitional care, they are more likely seek care in the emergency room during this period for non-urgent issues that do not require hospital admission. Therefore, we evaluated the use of emergency room (ER) care, hospital admissions, and trends in care before and after the age of 18 in children with spina bifida in Ontario, Canada. METHODS: We conducted a retrospective population-based cohort study of patients with spinal dysraphism in Ontario, Canada. We included all patients with spina bifida turning 18 years old in Ontario between Jan 1, 2002 to Dec 31, 2011, with data available at least 5 years before and after the age of 18. The primary outcome was ER visits. Secondary outcomes included hospital admissions. We estimated primary and secondary outcomes using negative binomial growth curve models, adjusting for patient-level baseline covariates. RESULTS: We identified 1,215 individuals diagnosed with spina bifida during the study period. Most of the cohort were females (N=660, 54.3%), and they lived within 50 km of a tertiary-care center (N=764, 62.9%). 503 patients (41.4%) had a diagnosis of neuropathic bladder. The annual rate of ER visits progressively increased from 68 visits per person years at age 13 to 105 visits at age 23. The rate of hospital admissions decreased from 29 admissions per person years at age 13 to 20 at age 23. In adjusted models, age had a null effect (RR 0.99; 95%CI 0.98-1.02), however there was a significant increase in the relative rate of ER visits at age 18 to 23 (RR 1.14; 95%CI 1.03-1.27). Patients in the lowest income quintile (RR 1.31; 95%CI 1.07-1.61), those living further than 50 km from a tertiary center (RR 1.42; 95%CI 1.16-1.73), those diagnosed with neuropathic bowel (RR 1.23; 95%CI 1.08-1.41) or bladder (RR 1.20; 95%CI 1.03-1.40), and those requiring mobility aids (RR 1.76; 95%CI 1.08-2.86) all had increased rates of ER visits. CONCLUSIONS: In children with spina bifida, the rate of ER visits increased significantly from age 18 to 23 relative to age 13 to 18, while hospital admission decreased over the same time. Transitional care should aim to reduce non-urgent emergency room visits, especially in those patients at greater risk of seeking emergency room care. Source of Funding: Functional Urology Research Group, University of Toronto Toronto, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e735-e735 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rano Matta* More articles by this author Christopher J.D. Wallis More articles by this author Humberto Vigil More articles by this author Armando Lorenzo More articles by this author Ronald T. Kodama More articles by this author Robert K. Nam More articles by this author Sidney B. Radomski More articles by this author Lesley K. Carr More articles by this author Sender Herschorn More articles by this author Expand All Advertisement PDF downloadLoading ...
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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".