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Impact of social complexity on outcomes in cystic fibrosis after transfer to adult care.

ABSTRACT: OBJECTIVE:This study evaluates the roles of medical and social complexity in health care use outcomes in cystic fibrosis (CF) after transfer from pediatric to adult care. METHODS:Retrospective cohort design included patients with CF who were transitioned into adult care at Indiana University from 2005 to 2015. Predictor variables included demographic and comorbidity data, age at transition, treatment complexity score (TCS), and an objective scoring measure of their social complexity (Bob's Level of Social Support, BLSS). Outcome variables included outpatient visit rates and hospitalization rates. Pearson's correlations and linear regression were used to analyze the data. RESULTS:The median age of the patients (N?=?133) at the time of transition was 20 (IQR 19-23) years. The mean FEV1 % predicted at transition was 69?±?24%. TCS correlated with outpatient visit rates (r?=?0.3, P?=?0.003), as well as hospitalization rates (r?=?0.4, P?

SUBMITTER: Crowley EM

PROVIDER: S-EPMC6487197 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Impact of social complexity on outcomes in cystic fibrosis after transfer to adult care.

Crowley Erin M EM Bosslet Gabriel T GT Khan Babar B Ciccarelli Mary M Brown Cynthia D CD

Pediatric pulmonology 20180402 6

<h4>Objective</h4>This study evaluates the roles of medical and social complexity in health care use outcomes in cystic fibrosis (CF) after transfer from pediatric to adult care.<h4>Methods</h4>Retrospective cohort design included patients with CF who were transitioned into adult care at Indiana University from 2005 to 2015. Predictor variables included demographic and comorbidity data, age at transition, treatment complexity score (TCS), and an objective scoring measure of their social complexi ...[more]

PMID: 29611352

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Project description:BackgroundDuring the COVID-19 pandemic, the University of Virginia adult cystic fibrosis (CF) center transitioned from in-person clinical encounters to a model that included interdisciplinary telemedicine. The pandemic presented an unprecedented opportunity to assess the impact of the interdisciplinary telemedicine model on clinical CF outcomes.Research questionWhat are the clinical outcomes of a care model that includes interdisciplinary telemedicine (IDC-TM) compared with in-person clinical care for patients with CF during the COVID-19 pandemic?Study design and methodsAdults with CF were included. The prepandemic year was defined as March 17, 2019, through March 16, 2020, and the pandemic year (PY) was defined as March 17, 2020, through March 16, 2021. Patients were enrolled starting in the PY. Prepandemic data were gathered retrospectively. Telemedicine visits were defined as clinical encounters via secured video communication. Hybrid visits were in-person evaluations by physician, with in-clinic video communication by other team members. In-person visits were encounters with in-person providers only. All encounters included previsit screening. Outcomes were lung function, BMI, exacerbations, and antibiotic use. FEV1 % predicted, exacerbations, and antibiotic use were adjusted for the effect of elexacaftor/tezacaftor/ivacaftor treatment.ResultsOne hundred twenty-four patients participated. One hundred ten patients were analyzed (mean age, 35 years; range, 18-69 years). Ninety-five percent had access to telemedicine (n = 105). Telemedicine visits accounted for 64% of encounters (n = 260), hybrid visits with telemedicine support accounted for 28% of encounters (n = 114), and in-person visits accounted for 7% of encounters (n = 30). No difference in lung function or exacerbation rate during the PY was found. BMI increased from 25 to 26 kg/m2 (t100 = -4.72; P < .001). Antibiotic use decreased from 316 to 124 episodes (z = 8.81; P < .0001).InterpretationThis CF care model, which includes IDC-TM, successfully monitored lung function and BMI, identified exacerbations, and followed guidelines-based care during the pandemic. A significant decrease in antibiotic use suggests that social mitigation strategies were protective.Trial registryClinicalTrials.gov; No.: NCT04402801; URL: www.clinicaltrials.gov.

Dataset Information

Impact of social complexity on outcomes in cystic fibrosis after transfer to adult care.

Publications

Impact of social complexity on outcomes in cystic fibrosis after transfer to adult care.

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