title: Identification of risk factors for an unsuccessful transition from pediatric to adult sickle cell disease care.
abstract: BACKGROUND
  A successful transition from pediatric to adult sickle cell disease (SCD) care is paramount to continued improvements in survival. In order to enhance transition success, our pediatric SCD transition process was modified to include combined adult and pediatric provider clinics that incorporated participation by our local SCD community-based organization. All children ages 16 and over participated in this newly-formed transition program.
  
  
  METHODS
  After 5 years of implementation of the modified SCD transition program, we retrospectively studied clinical and non-clinical risk factors for an unsuccessful transition. Risk factor categories studied included patient demographics, transition clinic attendance, and disease severity.
  
  
  RESULTS
  Thirty-two percent of patients did not transition successfully. Demographic factors such as gender, race, and type of insurance did not influence transition outcome, although travel distance to the adult SCD center was an identifiable risk factor for an unsuccessful transition. While transition clinic attendance rate did not affect transition outcomes, older age at first modified combined transition clinic visit was a significant risk factor for lack of transition. Patients with clinical markers of milder disease severity (SC and Sβ(+) genotypes and no chronic transfusion therapy) were at higher risk for an unsuccessful transition than patients with severe disease.
  
  
  CONCLUSIONS
  We have identified several risk factors for lack of transition success which will allow us to modify our transition efforts going forward to capture this highest risk subset.
authors.affiliation: Adult Sickle Cell Center, Division of Hematology-Oncology, University of Connecticut Health Center, Farmington, Connecticut.
authors.forename: Biree
authors.initials: B
authors.lastname: Andemariam
authors.forename: Jasmine
authors.initials: J
authors.lastname: Owarish-Gross
authors.forename: James
authors.initials: J
authors.lastname: Grady
authors.forename: Donna
authors.initials: D
authors.lastname: Boruchov
authors.forename: Roger S
authors.initials: RS
authors.lastname: Thrall
authors.forename: J Nathan
authors.initials: JN
authors.lastname: Hagstrom
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010372:Pediatrics; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology*; D015996:Survival Rate; D060305:Transition to Adult Care / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: sickle cell disease; transition