Frequency of Pediatric Encounters Predicts Timely Transfer to Adult Care for Youth With AutismFrequency of Pediatric Encounters Predicts Timely Transfer to Adult Care for Youth With Autism https://pediatricsnationwide.org/wp-content/uploads/2023/12/184718275-1024x683.png 1024 683 JoAnna Pendergrass, DVM JoAnna Pendergrass, DVM https://pediatricsnationwide.org/wp-content/uploads/2021/03/pendergrass_01.jpg
- December 28, 2023
- JoAnna Pendergrass, DVM
For adolescents and young adults with autism, the total number of pediatric appointments is strongly correlated with a timely transfer to adult care, while the reason for this correlation remains to be elucidated.
In a recent study, Laura Hart, MD, a pediatrician at Nationwide Children’s Hospital, and her research team reported a strong correlation between the total number of pediatric appointments and a timely transition to adult care for autistic adolescents and young adults.
Pediatric patients with autism face many challenges when transitioning to adult care, including the cessation of school support services, with fewer support services available in adulthood.
Systems differences between adult and pediatric care present more obstacles. For example, Dr. Hart explains that adult care providers receive little training on how to care for autistic patients. The switch from family- to individual-focused care can also be a difficult adjustment for pediatric patients with developmental disabilities.
Although the transition to adult care has been studied extensively from the pediatric side, comparatively little research has examined this transition from the adult side.
“One aim of our study was to build a bridge between the pediatric and adult sides of the research about autistic patients transitioning to adult care,” says Dr. Hart.
The researchers analyzed the electronic medical records of 224 adolescents and young adults with autism from January 2011 to May 2020 who had at least one appointment at Nationwide Children’s before their first appointment at The Center for Autism Services and Transition at The Ohio State University, directed by Chris Hanks, MD, who was also an author of the study.
They then used logistic regression modeling with forward feature selection to determine which categories of features, listed below, could predict a timely transfer to adult care (within six months of the most recent pediatric appointment):
- Patient encounters
- Insurance type
- Patient portal messages
- Patient vitals
- Completion of bloodwork
- Patient diagnoses
Forward feature selection is a method of machine learning. This strategy adds one variable at a time to the logistic regression model to determine which variable is most correlated with the outcome. To account for possible over-fitting, the models are cross-validated and re-run 5 times at each stage to ensure the findings are robust.
The patients were predominantly white (70%) and male (84%), with a median age of 18.6 years. Approximately 56% of patients had a timely transition to adult care.
Dr. Hart explains that either the total number of patient encounters or total outpatient encounters, which are highly correlated (r=0.99), were selected as the first variable in 91% of the 125 models that were run. This result suggests that these two variables are key predictors of a timely transfer to adult care.
“For autistic patients and their families who attended numerous pediatric appointments, we observed that there was not as big of a gap in care when transitioning to adult care,” she adds.
It is possible, the researchers note, that autistic patients who frequently attend their pediatric appointments are receiving transition education from their providers and are well prepared to make adult medical appointments.
In contrast, autistic patients who attend fewer pediatric appointments may need more support to ensure a timely transfer. From the pediatric side, this support includes sending transition education material through the mail, email, or patient portal and contacting patients who have not had a recent appointment.
For adult providers, Dr. Hart advises following up with autistic young adult patients who do not make their scheduled appointments after transitioning to adult care.
The researchers will continue to explore why such a strong correlation exists between the frequency of pediatric appointments and the timely transfer to adult care.
Other future research includes examining changes in prescriptions between pediatric and adult care and analyzing trends in health outcomes when autistic adolescents and young adults transition to adult care.
Hart LC, Sirrianni J, Rust S, Hanks C. Predicting timely transfer to adult care in a cohort of autistic adolescents and young adults. PLoS ONE. 2023 Sep 13. 18(9): e0289982.
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