title: Specialized survivor clinic attendance is associated with decreased rates of emergency department visits in adult survivors of childhood cancer.
abstract: BACKGROUND
  Survivors of childhood cancer are at considerable risk of experiencing treatment-related adverse health outcomes. To provide survivors with specialized care focused on these risks during adulthood, the government of Ontario funded a provincial network of specialized survivor clinics in 1999. The aim of this study was to determine whether prior attendance at survivor clinics by adult survivors of childhood cancer was associated with rates of emergency department (ED) visits.
  
  
  METHODS
  This was a population-based, retrospective cohort study using multiple linked administrative health databases. The cohort consisted of all adult survivors of childhood cancer diagnosed between January 1, 1986 and December 31, 2005 in Ontario, Canada. A recurrent event regression model was used to evaluate the association between prior attendance at survivor clinics and the rate of ED visits; adjustments were made for individual, demographic, treatment, and provider characteristics.
  
  
  RESULTS
  The study consisted of 3912 adult survivors of childhood cancer. Individuals who had at least 1 prior visit to a survivor clinic had a 19% decreased rate of ED visits in comparison with individuals who had not visited a survivor clinic (adjusted relative rate, 0.81; 95% confidence interval, 0.78-0.85). Each additional prior visit to a survivor clinic was associated with a 5% decrease in the rate of ED visits (adjusted relative rate, 0.95; 95% confidence interval, 0.93-0.96). These results were independent of whether or not survivors received care from a primary care physician.
  
  
  CONCLUSIONS
  Attendance at a specialized survivor clinic was significantly associated with decreased ED visits among adult survivors of childhood cancer.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: Rinku
authors.initials: R
authors.lastname: Sutradhar
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Pediatric Oncology Group of Ontario, Toronto, Canada.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Agha
authors.affiliation: Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.|Pediatric Oncology Group of Ontario, Toronto, Canada.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Pole
authors.affiliation: Pediatric Oncology Group of Ontario, Toronto, Canada.|Department of Pediatrics, University of Toronto, Toronto, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Greenberg
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.|Department of Pediatrics, University of Toronto, Toronto, Canada.
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Canada.|Princess Margaret Cancer Centre, Toronto, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Hodgson
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.|Department of Pediatrics, University of Toronto, Toronto, Canada.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Nathan
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods / Q000458:organization & administration*; D002648:Child; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy*; D009864:Ontario; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*
keywords: adult survivors of childhood cancer; emergency department visits; recurrent event model; relative rate; specialized survivor clinics; time-varying covariates