333 - How the Timing of Pediatric-to-Adult Healthcare Transfers Differs By Specialty in a Population of Commercially Insured Adolescents and Young Adults With Disabilities

Publication Number: 333.5477

Megumi J. Okumura, University of California, San Francisco, School of Medicine, SAN FRANCISCO, CA, United States; Alyna (LN. Chien, Boston Children's Hospital / Harvard Medical Schoo, Boston, MA, United States

Background: Adolescents and young adults with disabilities (AYA-D) likely benefit from pediatric-focused primary care and specialist physicians during childhood, but most guidelines recommend that such children make their pediatric-to-adult healthcare transition between 18-21 years of age. Previous studies on pediatric-to-adult healthcare transitions for AYA-D have focused on survey and Medicaid-based outcomes.

Objective: This study examines the ages at which commercially insured AYA-D begin using adult healthcare providers more frequently than their pediatric counterparts.

Design/Methods: This cross-sectional study uses five years of claims data (2012-2016) to identify 76,500 person-years of outpatient healthcare use among AYA-D aged 13-26. This population and their physicians were identified using a validated childhood-onset disability algorithm, claims are from a national commercial insurer, the national Health Systems and Provider Dataset, Outpatient visits were characterized according to the type of physicians billing for care—23 different types of pediatric-focused physicians (e.g., general pediatricians, pediatric cardiology) and 20 different types of adult-focused counterparts (e.g., family medicine, endocrinology). The timing of the pediatric-to-adult transfer was assessed by noting the age band at which the proportion of total outpatient visits was greater for physicians without pediatric-focused training versus those with.

Results: Exhibit 1 describes the demographic profile of AYA-D with disabilities, with 70.5% having 1 disabling type of impairment; 29.5% had 2 or more. The age at which the proportion of visits to adult primary care physicians became more frequent than those to general pediatrics occurred at age 19-20 (Exhibit 2). Many AYA-D were already being seen by non-pediatric more than pediatric ones before age 13-14 (Exhibit 3)—the occurred for 9 specialty types (e.g., allergy/immunology, dermatology), but between ages 15-16 and ages 19-20 for 8 specialty types (infectious diseases, neurology, rheumatology). All 19 pediatric-focused specialty types examined care for AYA-D up through ages 25-26.

Conclusion(s): Adolescents and young adults with disabilities may particularly benefit from seamless pediatric-to-adult healthcare transitions, and this study illustrates the timing of transfers occurring at a myriad of ages prior to adolescence and into late young adulthood. Healthcare providers may need to prepare patients for pediatric-to-adult healthcare transfer to occur at any age.

Exhibit 1. Characteristics of commercially insured adolescents and young adults with disabilities (AYA-D)


Exhibit 2. Proportion of visits made to pediatric and non-pediatric primary care physicians


Exhibit 3. Proportion of visits made to pediatric and non-pediatric specialists