Improved Rates of Successful Transfer of Care of Young Adults with Juvenile Idiopathic Arthritis with the Implementation of a Multi-Disciplinary Transition Clinic
Bibliographic record
Abstract
Objectives This study aimed to evaluate the efficacy of the implementation of a comprehensive juvenile idiopathic arthritis (JIA) transition clinic in improving the rates of successful transfer from a pediatric rheumatology team to an adult rheumatologist.[1] Methods We conducted a retrospective systematic chart review of all patients with JIA who attended their final Montreal Children’s Hospital appointment between 1992 and 2005 and compared them with the cohort who had their final appointment between 2013 and 2021. We tracked these patients for 2 years after transferring to an adult rheumatologist. If the patient never made contact with the identified adult rheumatologist or was lost to follow-up at 2 years, then this patient was deemed an unsuccessful transfer. Within the post-intervention group, we compared characteristics of patients with successful and unsuccessful transfers of care and looked at the services they received in the transition program. Variables pertaining to sex, disease characteristics, disease severity, psychosocial factors and the number of allied health care appointments attended as part of the multi-disciplinary program were examined. Univariate analyses were performed to assess factors associated with the outcome of successful transfer of care. Results In the pre-intervention cohort, 100 patient charts were reviewed. This was compared with 152 charts from the post-intervention cohort. Following the introduction of a multidisciplinary transition clinic, our rate of successful transfer increased from 48% in the pre-intervention period to 94% in the post-intervention cohort (see Table 1). Variables related to disease characteristics did not predict successful transfer of care. However, patients in the post-intervention group who attended more than 2 supplemental allied health appointments were more likely to have a successful transfer of care OR 14.3 (CI 2.89-70.92). Table 1. Characteristics of patients referred for transition to adult care following implementation of a comprehensive multi-disciplinary JIA transition clinic (n=152) Conclusion In the pre-intervention cohort, the 52% rate of unsuccessful transfer from pediatric to adult care mirrored the rates seen in other pediatric chronic illnesses. The improvement that we have seen in this rate reflects a sustained effort to address the unique needs of this patient population. We cannot draw conclusions about the value of any individual service offered through our transition program due to small numbers in the study. However, the inclusion of multiple allied health services did seem to improve overall outcomes, supporting our approach of a patient-centered model of transition of care. [1.] Hazel E. Pediatric Rheumatology 2010;8:2.
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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 | 0.004 | 0.029 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".