title: Transition experiences and health care utilization among young adults with type 1 diabetes.
abstract: BACKGROUND
  The purpose of this study was to describe the current status of adult diabetes care in young adults with type 1 diabetes and examine associations between health care transition experiences and care utilization.
  
  
  METHODS
  We developed a survey to assess transition characteristics and current care in young adults with type 1 diabetes. We mailed the survey to the last known address of young adults who had previously received diabetes care at a tertiary pediatric center.
  
  
  RESULTS
  Of 291 surveys sent, 83 (29%) were undeliverable and three (1%) were ineligible. Of 205 surveys delivered, 65 were returned (response rate 32%). Respondents (mean age 26.6 ± 3.0 years, 54% male, 91% Caucasian) transitioned to adult diabetes care at a mean age of 19.2 ± 2.8 years. Although 71% felt mostly/completely prepared for transition, only half received recommendations for a specific adult provider. Twenty-six percent reported gaps exceeding six months between pediatric and adult diabetes care. Respondents who made fewer than three diabetes visits in the year prior to transition (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.2-16.5) or cited moving/relocation as the most important reason for transition (OR 6.3, 95% CI 1.3-31.5) were more likely to report gaps in care exceeding six months. Patients receiving current care from an adult endocrinologist (79%) were more likely to report at least two diabetes visits in the past year (OR 6.0, 95% CI 1.5-24.0) compared with those receiving diabetes care from a general internist/adult primary care doctor (17%). Two-thirds (66%) reported receiving all recommended diabetes screening tests in the previous year, with no difference according to provider type.
  
  
  CONCLUSIONS
  In this sample, transition preparation was variable and one quarter reported gaps in obtaining adult diabetes care. Nevertheless, the majority endorsed currently receiving regular diabetes care, although visit frequency differed by provider type. Because locating patients after transition was incomplete, our findings suggest the need for standardized methods to track transitioning patients.
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Katharine C
authors.initials: KC
authors.lastname: Garvey
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.forename: Lori M
authors.initials: LM
authors.lastname: Laffel
authors.forename: Victoria
authors.initials: V
authors.lastname: Ochoa
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Wolfsdorf
authors.forename: Erinn T
authors.initials: ET
authors.lastname: Rhodes
keywords: health care delivery; transition to adult care; type 1 diabetes mellitus; young adults