title: Pediatric Orthopaedic Providers' Views on Transition From Pediatric to Adult Care.
abstract: BACKGROUND
  Surgical specialties are underrepresented in the discussions regarding transition and transfer of patients to adult care. We sought the pediatric orthopaedic perspective on types of patients seen into adulthood, age cut-offs, triggers for transfer, and barriers to transition. We examined provider demographic factors that may influence perspectives.
  
  
  METHODS
  An internet-based survey was sent to all members of the Pediatric Orthopaedic Society of North America and the Pediatric Orthopaedic Practitioner Society. Responses were voluntary and anonymous.
  
  
  RESULTS
  Response rates were 27% for the Pediatric Orthopaedic Society of North America and 24% for the Pediatric Orthopaedic Practitioner Society. Most respondents (70%) care for patients over the age of 25 years and many (35%) for patients over the age of 40. The most common conditions cared for were neuromuscular and congenital disorders. Respondents who worked in a fully salaried model reported caring for fewer of these adult patients compared with those working in other types of payment structure (P<0.001). Respondents working in free-standing children's hospitals reported fewer patients over 30 years old compared with nonchildren's hospital settings (P<0.001). There were no significant differences between profit-based and nonprofit settings. The top triggers for transfer to adult providers were: (1) adult comorbidities; (2) transition to medical specialist; and (3) institutional policy. The top barriers to transfer were: (1) lack of qualified adult providers; (2) institutional policy; and (3) on-going surgical issues.
  
  
  CONCLUSIONS
  Many providers care for older patients, often using external triggers for transfer to adult care. Financial considerations may need to be further explored. Variation in care may be aided by national society guidelines.
  
  
  METHODS
  Level III-survey research.
authors: *Division of Gastroenterology, Hepatology and Nutrition †Department of Orthopedics, Boston Children's Hospital, Boston, MA.
authors: Laurie N
authors: LN
authors: Fishman
authors: Rachel
authors: R
authors: DiFazio
authors: Patricia
authors: P
authors: Miller
authors: Susan
authors: S
authors: Shanske
authors: Peter M
authors: PM
authors: Waters
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D005260:Female; D019538:Health Care Surveys; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D020380:Needs Assessment; D009468:Neuromuscular Diseases / Q000453:epidemiology / Q000628:therapy; D009985:Orthopedics / Q000379:methods / Q000706:statistics & numerical data; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data; D060305:Transition to Adult Care / Q000592:standards / Q000706:statistics & numerical data