Clinical outcome in relation to care in centres specialising in cystic fibrosis: cross sectional study.
OBJECTIVE
To assess the effect on clinical outcome of managing paediatric and adult patients with cystic fibrosis at specialised cystic fibrosis centres.


METHODS
Cross sectional study.


METHODS
Two adult cystic fibrosis centres in the United Kingdom.


METHODS
Patients from an adult cystic fibrosis centre in Manchester were subdivided into those who had received continuous care from paediatric and adult cystic fibrosis centres (group A), and those who had received paediatric care in a centre not specialising in cystic fibrosis followed by adult care in a cystic fibrosis centre (group B). Group C were referrals to the new adult cystic fibrosis centre in Cambridge who had received neither paediatric nor adult centre care for their cystic fibrosis.


METHODS
Body mass index (weight (kg)/height (m2)), lung function (forced expiratory volume in one second (FEV1 percentage of predicted)), the Northern chest x ray film score, and age at colonisation with Pseudomonas aeruginosa.


RESULTS
A prominent stepwise increase in body mass index was associated with increasing amounts of care at a cystic fibrosis centre; 18.3, 20.2, and 21.3 for groups C, B, and A respectively (P<0.001). Improved nutritional status was correlated with a higher FEV1 and better (lower) chest x ray film scores; r=0. 52 and -0.45 respectively (P<0.001 for both).


CONCLUSIONS
These findings provide the first direct evidence that management of cystic fibrosis in paediatric and adult cystic fibrosis centres results in a better clinical outcome, and strongly supports the provision of these specialist services.
Mahadeva
R
R
Department of Haematology, University of Cambridge, Medical Research Council Centre, Cambridge CB2 2QH.
Webb
K
K
Westerbeek
R C
RC
Carroll
N R
NR
Dodd
M E
ME
Bilton
D
D
Lomas
D A
DA
D000328:Adult; D017668:Age of Onset; D015992:Body Mass Index; D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D004739:England; D005260:Female; D005541:Forced Expiratory Volume; D006782:Hospitals, Special / Q000592:standards*; D006801:Humans; D008297:Male; D011552:Pseudomonas Infections / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome