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Delayed Transition of Care: A National Study of Visits to Pediatricians by Young Adults

  • Robert J. Fortuna
    Correspondence
    Address correspondence to Robert J. Fortuna, MD, MPH, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY 14609.
    Affiliations
    Center for Primary Care and Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY

    Strong Children's Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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  • Jill S. Halterman
    Affiliations
    Strong Children's Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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  • Tiffany Pulcino
    Affiliations
    Center for Primary Care and Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
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  • Brett W. Robbins
    Affiliations
    Center for Primary Care and Department of Internal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY

    Strong Children's Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
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      Abstract

      Objective

      Despite numerous policy statements and an increased focus on transition of care, little is known about young adults who experience delayed transition to adult providers.

      Methods

      We used cross-sectional data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey between 1998 and 2008 to examine delayed transition among young adults ages 22 to 30. We defined delayed transition as continuing to visit a pediatrician after the age of 21 years.

      Results

      Overall, we found that 1.3% (95% confidence interval [CI] 1.1–1.7) of visits by young adults to primary care physicians were seen by pediatricians, approximately 445,000 visits per year. We did not find a significant change in delayed transition during the past decade (β = −.01; P = .77). Among young adults, visits to pediatricians were more likely than visits to adult-focused providers to be for a chronic disease (25.7% vs 12.6%; P = .002) and more likely to be billed to public health insurance (23.5% vs 14.1%; P = .01). In adjusted models, visits by young adults to pediatric healthcare providers were more likely associated with chronic disease (adjusted relative risk [ARR] 2.2; 95% CI 1.5–3.4), with public health insurance (ARR 1.9; 95% CI 1.3–2.9), or with no health insurance (ARR 1.9; 95% CI 1.1–3.4).

      Conclusions

      Although most young adult visits were to adult providers, a considerable number of visits were to pediatricians, indicating delayed transition of care. There has been no substantial change in delayed transition during the past decade. Visits by young adults with chronic disease, public health insurance, or no health insurance were more likely to experience delayed transition of care.

      Keywords

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