Analysis of health care claims during the peri-transfer stage of transition from pediatric to adult care among juvenile idiopathic arthritis patients.
BACKGROUND
To investigate the utilization of health care services before and after transfer from pediatric to adult rheumatology care in clinical practice.


METHODS
Using US commercial claims data from January 2005 through August 2012, we identified individuals with a JIA diagnosis code from a pediatric rheumatologist followed by any diagnosis code from an adult rheumatologist. Individuals had 6 months observable time before the last pediatric visit and 6 months after the first adult visit. Medication, emergency room, physical therapy use, and diagnosis codes were compared between the pediatric and adult interval using McNemar's test. The proportion of days covered (PDC) of TNFi for the time between last pediatric and first adult visit was calculated.


RESULTS
We identified 58 individuals with JIA who transferred from pediatric to adult rheumatology care after the age of 14. The median age at the last pediatric rheumatology visit was 18.1 years old and the median transfer interval was 195 days. 29 % of patients received NSAIDs in the adult interval compared to 43 % in the pediatric interval (p = 0.06). In the pediatric interval, 71 % received a JRA and 0 % received an RA physician diagnosis code compared to 28 and 45 %, respectively, in the adult interval. The median PDC for patients receiving a TNFi was 0.75 during the transfer interval.


CONCLUSIONS
Individuals with JIA who transferred to adult care were more likely receive a diagnosis of RA instead of JRA and were less likely to receive NSAIDs, but had no significant immediate changes to other medication use.
Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, 1600 7th Ave S, CPPN M10, Birmingham, AL, 35209, USA. mmannion@peds.uab.edu.
Melissa L
ML
Mannion
Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th St South, FOT 802, Birmingham, AL, 35294, USA.
Fenglong
F
Xie
Department of Medicine, Division of Infectious Disease, University of Alabama at Birmingham, 1900 University Blvd, THT 229, Birmingham, AL, 35294, USA.
John
J
Baddley
Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th St South, FOT 802, Birmingham, AL, 35294, USA.
Lang
L
Chen
Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th St South, FOT 802, Birmingham, AL, 35294, USA.
Jeffrey R
JR
Curtis
Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th St South, FOT 802, Birmingham, AL, 35294, USA.
Kenneth
K
Saag
Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th St South, FOT 802, Birmingham, AL, 35294, USA.
Jie
J
Zhang
Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, 1600 7th Ave S, CPPN M10, Birmingham, AL, 35209, USA.
Timothy
T
Beukelman
D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data; D012219:Rheumatology / Q000379:methods / Q000706:statistics & numerical data; D060305:Transition to Adult Care / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States
D018501:Antirheumatic Agents
Administrative claims; Juvenile idiopathic arthritis (JIA); Transition to adult care