Transitioning from Pediatric to Adult Care: impact on hospitalizations and eye examinations in adolescents and young adults with diabetes mellitus in Ontario
Bibliographic record
Abstract
During the transition to adult healthcare, young adults with diabetes mellitus (DM) are at an increased risk of leaving medical supervision. Previous studies have been mostly descriptive, with low sample sizes, and poor attention to selection and other types of biases. The objectives of this study were to describe the rates of acute diabetes-related complications and the proportion of patients receiving eye examinations before and after age 18 years (age of transfer to adult care), and to test whether different methods of transfer are associated with improved outcomes and processes of care. This study was a retrospective cohort study of 1507 young adults with prevalent diabetes mellitus of at least 5 years duration by age 16 years between 1996 and 2002 with follow-up until aged 20 years. Data was obtained from administrative health care databases and a census of pediatric diabetes centers in Ontario, Canada. DM-related hospitalization rates increased from 7.6 per 100 patient-years to 9.5 per 100 patient-years in the 2 years prior to and after transfer to adult care (p =0.03). After controlling for other factors patients who were transitioned to a new physician and allied health care team were more likely to be hospitalized than those who had continuity with at least part of the pediatric team (RR 1.50; 95% confidence interval [CI], 1.02-2.22). Predictors of hospitalizations included prior DM hospitalizations (RR 2.30; 95% CI, 1.88-2.90), decreased socioeconomic status (RR 2.11; 95% CI 1.23-3.86), females (RR 1.50; 95% CI, 1.07-2.11) and low level of physician supply (RR 1.71; 95% CI, 1.04-2.82). The proportion of individuals having at least one eye-care examination decreased slightly from 72% during the two years prior to transition to 70% following transition (p = 0.06). The odds of having an eye-care visit after transition was associated with decreasing neighborhood income (OR 0.49; 95% CI 0.33-0.73), female gender (OR 1.95; 95% CI, 1.53- 2.48) and previous eye
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".