title: Health Care Use During Transfer to Adult Care Among Youth With Chronic Conditions.
abstract: OBJECTIVE
  To compare health care use and costs for youth with chronic health conditions before and after transfer from pediatric to adult health care services.
  
  
  METHODS
  Youth born in Ontario, Canada, between April 1, 1989, and April 1, 1993, were assigned to 11 mutually exclusive, hierarchically arranged clinical groupings, including "complex" chronic conditions (CCCs), non-complex chronic conditions (N-CCCs), and chronic mental health conditions (CMHCs). Outcomes were compared between 2-year periods before and after transfer of pediatric services, the subjects' 18th birthday.
  
  
  RESULTS
  Among 104,497 youth, mortality was highest in those with CCCs, but did not increase after transfer (1.3% vs 1.5%, P = .55). Costs were highest among youth with CCCs and decreased after transfer (before and after median [interquartile range]: $4626 [1253-21,435] vs $3733 [950-16,841], P < .001);Costs increased slightly for N-CCCs ($569 [263-1246] vs $589 [262-1333], P < .001), and decreased for CMHCs ($1774 [659-5977] vs $1545 [529-5128], P < .001). Emergency department visits increased only among youth with N-CCCs (P < .001). High-acuity emergency department visits increased CCCs (P = .04) and N-CCCs (P < .001), but not for CMHC (P = .59), who had the highest visit rate. Among the 11 individual conditions, costs only increased in youth with asthma (P < .001), and decreased (P < .05) in those with neurologic impairment, lupus, inflammatory bowel disease, and mood/affective disorders.
  
  
  CONCLUSIONS
  Pediatric transfer to adult care is characterized by relatively stable short-term patterns of health service use and costs among youth with chronic conditions.
authors.affiliation: Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Commonwealth Fund/CFHI Harkness Fellow in Health Care Policy and Practice, New York, New York; eyal.cohen@sickkids.ca.
authors.forename: Eyal
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;
authors.forename: Sima
authors.initials: S
authors.lastname: Gandhi
authors.affiliation: Department of Pediatrics, and Adolescent Medicine, and Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Alene
authors.initials: A
authors.lastname: Toulany
authors.affiliation: Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Moore
authors.affiliation: Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;
authors.forename: Longdi
authors.initials: L
authors.lastname: Fu
authors.affiliation: Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and Centre for Research on Inner City Health, Li Ka Shing, Keenan Research Center, and.
authors.forename: Julia
authors.initials: J
authors.lastname: Orkin
authors.affiliation: Department of Pediatrics, and Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada;
authors.forename: Deborah
authors.initials: D
authors.lastname: Levy
authors.affiliation: Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Respirology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Stephenson
authors.affiliation: Divisions of Pediatric Medicine and Child Health Evaluative Sciences, Department of Pediatrics, and Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D060305:Transition to Adult Care / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult