P543 Structured transition enhances clinical outcome without an increase in healthcare cost in adolescent patients with IBD: the UK TRANSIT study
McCartney S.*1, Lindsay J.2, Russell R.3, Gaya D.3, Shaw I.4, Murray C.5, Finney-Hayward T.6, Sebastian S.7
1University College London Hospitals NHS Foundation Trust, London, United Kingdom 2Barts Health NHS Trust, London, United Kingdom 3NHS Greater Glasgow and Clyde, Glasgow, United Kingdom 4Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom 5Royal Free London NHS Foundation Trust, London, United Kingdom 6AbbVie, Maidenhead, United Kingdom 7Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom
IBD presents in childhood/adolescence in up to 25% of patients. Evidence that a coordinated transition programme prior to transfer to adult care improves outcomes is lacking. The TRANSIT study compared the impact of transition vs non-transition on outcome and hospital resource utilisation in patients with IBD.
TRANSIT was an observational retrospective case note review and prospective patient questionnaire study of patient outcome conducted in 11 UK centres. Consenting patients with a confirmed diagnosis of IBD before age 16 with ≥12 months' care under adult services and aged ≥16 years at recruitment were included. Structured transition visits in this study were defined as involving clinical staff from both paediatric and adult services. Transition patients attended ≥2 and non-transition patients zero transition visits. The index date was defined as the first visit involving adult IBD services. Data on IBD disease flares (defined as any CD- or UC-related hospitalisations, or increases CD/UC therapy) and hospital resource utilisation for 12-months pre- and post-index visit were collected retrospectively from medical records.
Patient demographic and clinical characteristics at recruitment were similar in transition (n=95; median age 19.6 years; 47% female; 78% CD; median 2.1 years post-index) and non-transition patients (n=34; median age 19.3 years; 41% female; 74% CD; median 2.3 years post-index; all p>0.05). Transition patients had significantly fewer flares/patient in the 12 months post-index (0.4 [SD: 0.8]) vs non-transition patients (1.0 [SD: 1.4], p<0.05), whereas mean flares/patient in the 12 months pre-index were similar (transition 0.4 [SD: 0.9] vs non-transition 0.6 [SD: 0.9], p>0.05). Non-elective admissions and associated costs were lower whereas elective inpatient and outpatient attendances and associated costs were higher in transition vs non-transition patients (see table). The mean total cost of hospital attendances/patient in the 12-month post index period in transition and non-transition patients were £1,537.64 and £1,573.65, respectively.
These data show structured transition enhances clinical outcome with no increase in hospital utilisation cost. This suggests that structured transition may be a better use of healthcare resource.