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Hospitalization patterns change as young people with congenital heart disease transition from adolescence to adulthood
Due to improved diagnosis and treatment, 85 to 90 percent of children born with congenital heart disease (CHD) in the United States will survive to adulthood. Yet, between 18 and 23 years of age, many of these youth will lose public or parental insurance and will struggle to obtain comprehensive health insurance. During this transition period, twice as many of those aged 21 to 23 years than those aged 15 to 17 years are admitted to the hospital via the emergency department (ED), according to a new study.
One reason underlying this difference may be the loss of insurance during the transition to adulthood, notes Michelle Z. Gurvitz, M.D., M.S., of Children's Hospital and Regional Medical Center in Seattle. She and coinvestigators studied data on CHD patients aged 12 to 44 years, from the 2000 to 2003 California hospital discharge database.
Overall, there were 9,017 hospitalizations at 368 hospitals. The proportion of patients admitted via the ED nearly doubled during the transition to adulthood, beginning at age 18. Those with public insurance were 2.3 times more likely and the uninsured were 4.6 times more likely than the privately insured to be admitted to the hospital via the ED. Hospitalization patterns also changed when CHD patients reached 21 years, often the age when patients can no longer be admitted to a children's hospital or a pediatric ward.
For example, for patients aged 12 to 20 years, 12 of the most CHD-experienced hospitals accounted for 70 percent of hospitalizations. For patients 21 to 44 years, 25 of the more CHD-experienced hospitals accounted for only 45 percent of cases. Perhaps because most CHD specialists are located at children's hospitals, older CHD patients end up diversifying to a larger number of general adult cardiologists and hospitals with less CHD experience, which may affect their clinical outcomes. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00046).
See "Changes in hospitalization patterns among patients with congenital heart disease during the transition from adolescence to adulthood," by Dr. Gurvitz, Moira Inkelas, Ph.D., Maggie Lee, M.P.H., and others, in the February 27, 2007, Journal of the American College of Cardiology 49(8), pp. 875-882.
Editor's Note: Another related AHRQ-supported study (HS10399) found that over 6 percent of people (mostly infants) undergoing median sternotomy (cracking open the breast bone) for congenital heart disease developed postoperative bloodstream infections, and that certain factors increased the risk of these infections. For more details, see: Shah, S.S., Kagen, J., Lautenbach, E., and others (2007, February). "Bloodstream infections after median sternotomy at a children's hospital." Journal of Thoracic and Cardiovascular Surgery 133, pp. 435-440.
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