77 - Changes in Pediatric Hospital Use from 1996-2016 by Adolescents and Young Adults With Chronic Conditions of Childhood

The AAP co-authored guidelines in 2002 recommending that adolescents and young adults (AYA) transition from pediatric to adult care by 21 years old. The Cystic Fibrosis (CF) Foundation included transition recommendations in CF center accreditation since 2004. Yet, the effects of these guidelines on the transition process are largely unexplored. While AYA -particularly those with CF and other chronic conditions-continue to use pediatric hospitals past the age 21, the proportion of pediatric versus adult hospital use for this AYA population is unknown.

Objective:

Characterize pediatric hospital use of AYA with CF, congenital heart disease (CHD), and sickle cell disease (SCD) by 1) diagnosis 2) age; and 3) year.

Design/Methods:

We conducted a repeated cross-sectional analysis of all hospital discharges for AYA ages 12-35 years with CF, CHD, and SCD in the 1996-2016 Agency for Healthcare Research and Quality’s State Inpatient Databases (SID) from six states. CF, CHD, and SCD were chosen for comparison due to similarities in hospital use, health trajectories, and pediatric to adult care transition needs during the transition period. We identified AYA with CF, CHD and SCD by ICD-9 and -10 diagnosis codes. We categorized hospital types (pediatric hospitals versus adult hospitals) using a validated and published classification scheme. We categorized age to reflect pre-transition (12-17 years), transition (18-21 years), and post-transition (22-35 years) ages. Trends in hospital type used were assessed with Cochrane-Armitage test.

Results:

We identified 545,169 total discharges for AYA ages 12-35 years with CF, CHD, and SCD (Table 1), of which 6% were to pediatric hospitals. AYA with SCD had a smaller proportion of discharges from pediatric hospitals (3.4%) compared to AYA with CHD (10.4%) and CF (14.1%). Few AYA 22-35 years used pediatric hospitals (Figure 1). However, from 1996 to 2016 AYA with CHD had significantly increasing pediatric hospital use (1.2% to 2.31%, p < 0.001). Conversely, over the same time period AYA with CF (4.8% to 0.1%, p = 0.009) and SCD (0.06% to 0.03%, p = 0.008) had significantly decreasing pediatric hospital use.

Conclusion(s):

AYA with CF, CHD, and SCD have differences in the proportions using pediatric hospitals at all transition ages during the 20-year study period. The decrease in pediatric hospital use by AYA 22-35 years with CF may reflect CF center accreditation standards. However, the diverging trends in pediatric hospital use during the study period for AYA 22-35 years with CHD versus SCD may represent an underlying healthcare disparity during the transition process.