Adult Survivors of Pediatric Illness: The Impact on Pediatric Hospitals

Goodman, Denise M.; Mendez, Eduardo; Throop, Cheri; Ogata, Edward S.

doi:10.1542/peds.110.3.583

Cited by 54 publications

(54 citation statements)

References 20 publications

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“…Two papers did not correspond with the definitions of palliative care outlined in table 1, and these were: epidermolysis bullosa61 and paediatric illness (empirical) 26. Both highlighted the importance of having transition programs because of the increasing numbers of young people surviving into adulthood and the role of the family in improving the transition process.…”

Section: Resultsmentioning

confidence: 99%

Transition to adult services for children and young people with palliative care needs: a systematic review

Doug

Adi

Williams

et al. 2009

Archives of Disease in Childhood

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Objective To evaluate the evidence on the transition process from child to adult services for young people with palliative care needs. Design Systematic review. Setting Child and adult services and interface between healthcare providers. Patients Young people aged 13-24 years with palliative care conditions in the process of transition. Main outcome measures Young people and their families' experiences of transition, the process of transition between services and its impact on continuity of care and models of good practice. Results 92 studies included. Papers on transition services were of variable quality when applied to palliative care contexts. Most focussed on common life-threatening and life-limiting conditions. No standardised transition program identifi ed and most guidelines used to develop transition services were not evidence-based. Most studies on transition programs were predominantly condition-specifi c (eg, cystic fi brosis (CF), cancer) services. CF services offered high-quality transition with the most robust empirical evaluation. There were differing condition-dependent viewpoints on when transition should occur but agreement on major principles guiding transition planning and probable barriers. There was evidence of poor continuity between child and adult providers with most originating from within child settings. Conclusions Palliative care was not, in itself, a useful concept for locating transition-related evidence. It is not possible to evaluate the merits of the various transition models for palliative care contexts, or their effects on continuity of care, as there are no long-term outcome data to measure their effectiveness. Use of validated outcome measures would facilitate research and service development.

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Section: Resultsmentioning

confidence: 99%

Transition to adult services for children and young people with palliative care needs: a systematic review

Doug

Adi

Williams

et al. 2009

Archives of Disease in Childhood

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“…5 Although patients' needs within specific disease categories have been characterized, 4, few investigators have looked at this patient population in aggregate, and the utilization of inpatient treatment facilities by these patients has been poorly described. [31][32][33][34] As efforts to reform health care intensify, an assessment of hospital care for adults with chronic conditions originating in childhood is needed to facilitate the optimal allocation of resources to meet the needs of this population.…”

mentioning

confidence: 99%

Adults With Chronic Health Conditions Originating in Childhood: Inpatient Experience in Children's Hospitals

et al. 2011

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WHAT'S KNOWN ON THIS SUBJECT:Health care innovations have improved survival in children with conditions previously fatal in childhood. Implications for specific diseases have been reported, but little information is available on disease comparisons or population increases in adult survivors of childhood illness. WHAT THIS STUDY ADDS:In this study of adults with chronic childhood diseases treated at 30 children's hospitals over a 10-year period, 6 conditions were compared and patient population growth was projected. The disparity between diagnoses suggests the existence of systemic barriers to the transition of these patients to adult health care providers. abstract OBJECTIVE: To describe the rate of increase of the population of adults seeking care as inpatients in children's hospitals over time. PATIENTS AND METHODS:We analyzed data from January 1, 1999, to December 31, 2008, from patients hospitalized at 30 academic children's hospitals, including growth rates according to age group (pediatric: aged Ͻ18 years; transitional: aged 18 -21 years; or adult: aged Ͼ21 years) and disease. RESULTS:There were 3 343 194 hospital discharges for 2 143 696 patients. Transitional patients represented 2.0%, and adults represented 0.8%, totaling 59 974 patients older than 18 years. The number of unique patients, admissions, patient-days, and charges increased in all age groups over the study period and are projected to continue to increase. Resource use was disproportionately higher in the older ages. The growth of transitional patients exceeded that of others, with 6.9% average annual increase in discharges, 7.6% in patient-days, and 15% in charges. Chronic conditions occurred in 87% of adults compared with 48% of pediatric patients. Compared with pediatric patients, the rates of increase of inpatient-days increased significantly for transitional age patients with cystic fibrosis, malignant neoplasms, and epilepsy, and for adults with cerebral palsy. Annual growth rates of charges increased for transitional and adult patients for all diagnoses except cystic fibrosis and sickle cell disease. CONCLUSIONS:The population of adults with diseases originating in childhood who are hospitalized at children's hospitals is increasing, with varying disease-specific changes over time. Our findings underscore the need for proactive identification of strategies to care for adult survivors of pediatric diseases. Pediatrics 2011;128:5-13

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“…This finding contrasts with another study in which adult survivors of pediatric illness accounted for 4.9% of all pediatric hospital discharges but accrued 6.3% of total inpatient charges. 9 However, our study population is surgical, and our results may be explained by the fact that pediatric patients undergo highly complex surgical procedures such as the Norwood operation that require an enormous amount of resources to provide adequate care. This is supported by the breakdown of total charges by surgical risk category in Figure 2 that demonstrates higher median total charges for risk category 4ϩ procedures in the pediatric population versus adults.…”

Section: Impact Of Ach Surgery In Pediatric Hospitalsmentioning

confidence: 99%

“…9 As the adult congenital cardiology population progressively grows, the resources required by hospitals to care for this population will increase. We demonstrated that although the number and proportion of congenital heart surgery admissions in pediatric hospitals is increasing, presently these adult admissions do not consume a disproportionate amount of resources among these hospitals.…”

Section: Impact Of Ach Surgery In Pediatric Hospitalsmentioning

confidence: 99%

Resource Use Among Adult Congenital Heart Surgery Admissions in Pediatric Hospitals

Kim

Gauvreau

Bacha

et al. 2011

Circ: Cardiovascular Quality and Outcomes

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Background-Pediatric hospitals frequently perform congenital heart surgery in adults with congenital heart disease. The impact of these admissions on pediatric hospital resources is unknown. Our goals were to examine resource use by adults undergoing congenital heart surgery in pediatric hospitals, explore the association between high resource use (HRU) and inpatient death, and identify HRU risk factors. Methods and Results-We obtained inpatient data from 42 pediatric hospitals from 2000 to 2008 and selected adult congenital heart (ACH) surgery admissions. We defined HRU admissions as those exceeding the 90th percentile for total hospital charges. We performed multivariable analyses using generalized estimating equations to identify risk factors for HRU. Of 97 563 congenital heart surgery admissions to pediatric hospitals, 3061 (3.1%) were adults, accounting for 2.2% of total hospital charges.

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Adult Survivors of Pediatric Illness: The Impact on Pediatric Hospitals

Cited by 54 publications

References 20 publications

Transition to adult services for children and young people with palliative care needs: a systematic review

Transition to adult services for children and young people with palliative care needs: a systematic review

Adults With Chronic Health Conditions Originating in Childhood: Inpatient Experience in Children's Hospitals

Resource Use Among Adult Congenital Heart Surgery Admissions in Pediatric Hospitals

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