Impact of social complexity on outcomes in cystic fibrosis after transfer to adult care. Issue 6 (2nd April 2018)

• Record Type: Journal Article
• Authors: Crowley, Erin M.; Bosslet, Gabriel T.; Khan, Babar; Ciccarelli, Mary; Brown, Cynthia D.
• Is Part Of: Pediatric pulmonology. Volume 53:Issue 6(2018)
• Page Start: 735
• Page End: 740
• Publication Date: 2018-04-02
• Subjects: cystic fibrosis (CF) -- health care outcomes -- health care transition -- social complexity -- social dimensions of pulmonary medicine; Pediatric respiratory diseases -- Periodicals; Pediatrics -- Periodicals; 618.922
• DOI: 10.1002/ppul.23997
• Languages: English
• ISSNs: 8755-6863

Abstract

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 < 0.001); while the BLSS only correlated with hospitalization rates ( r = 0.7, P < 0.001). After adjusting for covariates, the strongest predictors of post‐transfer hospitalizations are BLSS ( P < 0.0001) and pre‐transfer hospitalization rate ( P < 0.0001). Conclusion: Greater treatment complexity is associated with greater healthcare utilization overall, while greater social complexity is associated with increased hospitalizations (but not outpatient visits). Screening young adults for social complexity may identify high‐risk subpopulations and allow for patient centered interventions to support them and prevent avoidable health care use.