Estimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data

Introduction Healthcare transitions, including from paediatric to adult services, can be disruptive and cause a lack of continuity in care. Existing research on the paediatric-adult healthcare transition often uses a simple age cut-off to assign transition status. This risks misclassification bias,...

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Autores principales:	Stuart William Jarvis, Gerry Richardson, Kate Flemming, Lorna Fraser
Formato:	article
Lenguaje:	EN
Publicado:	Swansea University 2021
Materias:	Demography. Population. Vital events HB848-3697
Acceso en línea:	https://doaj.org/article/a4b160fab4624d058646517809ce642c
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spelling	oai:doaj.org-article:a4b160fab4624d058646517809ce642c2021-12-03T15:47:28ZEstimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data10.23889/ijpds.v6i1.16852399-4908https://doaj.org/article/a4b160fab4624d058646517809ce642c2021-11-01T00:00:00Zhttps://ijpds.org/article/view/1685https://doaj.org/toc/2399-4908 Introduction Healthcare transitions, including from paediatric to adult services, can be disruptive and cause a lack of continuity in care. Existing research on the paediatric-adult healthcare transition often uses a simple age cut-off to assign transition status. This risks misclassification bias, reducing observed changes at transition (adults are included in the paediatric group and vice versa) possibly to differing extents between groups that transition at different ages. Objective To develop and assess methods for estimating the transition point from paediatric to adult healthcare from routine healthcare records. Methods A retrospective cohort of young people (12 to 23 years) with long term conditions was constructed from linked primary and secondary care data in England. Inpatient and outpatient records were classified as paediatric or adult based on treatment and clinician specialities. Transition point was estimated using three methods based on record classification (First Adult: the date of first adult record; Last Paediatric: date of last paediatric record; Fitted: a date determined by statistical fitting). Estimated transition age was compared between methods. A simulation explored impacts of estimation approaches compared to a simple age cut-off when assessing associations between transition status and healthcare events. Results Simulations showed using an age-based cut-off at 16 or 18 years as transition point, common in research on transition, may underestimate transition-associated changes. Many health records for those aged 14 years were classified as adult, limiting utility of the First Adult approach. The Last Paediatric approach is least sensitive to this possible misclassification and may best reflect experience of the transition. Conclusions Estimating transition point from routine healthcare data is possible and offers advantages over a simple age cut-off. These methods, adapted as necessary for data from other countries, should be used to reduce risk of misclassification bias in studies of transition in nationally representative data. Stuart William JarvisGerry RichardsonKate FlemmingLorna FraserSwansea UniversityarticleDemography. Population. Vital eventsHB848-3697ENInternational Journal of Population Data Science, Vol 6, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Demography. Population. Vital events HB848-3697
spellingShingle	Demography. Population. Vital events HB848-3697 Stuart William Jarvis Gerry Richardson Kate Flemming Lorna Fraser Estimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data
description	Introduction Healthcare transitions, including from paediatric to adult services, can be disruptive and cause a lack of continuity in care. Existing research on the paediatric-adult healthcare transition often uses a simple age cut-off to assign transition status. This risks misclassification bias, reducing observed changes at transition (adults are included in the paediatric group and vice versa) possibly to differing extents between groups that transition at different ages. Objective To develop and assess methods for estimating the transition point from paediatric to adult healthcare from routine healthcare records. Methods A retrospective cohort of young people (12 to 23 years) with long term conditions was constructed from linked primary and secondary care data in England. Inpatient and outpatient records were classified as paediatric or adult based on treatment and clinician specialities. Transition point was estimated using three methods based on record classification (First Adult: the date of first adult record; Last Paediatric: date of last paediatric record; Fitted: a date determined by statistical fitting). Estimated transition age was compared between methods. A simulation explored impacts of estimation approaches compared to a simple age cut-off when assessing associations between transition status and healthcare events. Results Simulations showed using an age-based cut-off at 16 or 18 years as transition point, common in research on transition, may underestimate transition-associated changes. Many health records for those aged 14 years were classified as adult, limiting utility of the First Adult approach. The Last Paediatric approach is least sensitive to this possible misclassification and may best reflect experience of the transition. Conclusions Estimating transition point from routine healthcare data is possible and offers advantages over a simple age cut-off. These methods, adapted as necessary for data from other countries, should be used to reduce risk of misclassification bias in studies of transition in nationally representative data.
format	article
author	Stuart William Jarvis Gerry Richardson Kate Flemming Lorna Fraser
author_facet	Stuart William Jarvis Gerry Richardson Kate Flemming Lorna Fraser
author_sort	Stuart William Jarvis
title	Estimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data
title_short	Estimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data
title_full	Estimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data
title_fullStr	Estimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data
title_full_unstemmed	Estimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data
title_sort	estimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data
publisher	Swansea University
publishDate	2021
url	https://doaj.org/article/a4b160fab4624d058646517809ce642c
work_keys_str_mv	AT stuartwilliamjarvis estimationofageoftransitionfromchildrenstoadulthealthcareforyoungpeoplewithlongtermconditionsusinglinkedroutinelycollectedhealthcaredata AT gerryrichardson estimationofageoftransitionfromchildrenstoadulthealthcareforyoungpeoplewithlongtermconditionsusinglinkedroutinelycollectedhealthcaredata AT kateflemming estimationofageoftransitionfromchildrenstoadulthealthcareforyoungpeoplewithlongtermconditionsusinglinkedroutinelycollectedhealthcaredata AT lornafraser estimationofageoftransitionfromchildrenstoadulthealthcareforyoungpeoplewithlongtermconditionsusinglinkedroutinelycollectedhealthcaredata
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Estimation of age of transition from children's to adult healthcare for young people with long term conditions using linked routinely collected healthcare data

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