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Transfer from pediatric to adult healthcare services for home mechanical ventilation users

Abstract RATIONALE: The prevalence of children supported with home mechanical ventilation (HMV) is growing and advances in medical care have led to an increasing number surviving to adulthood. Transition to adult healthcare services is poorly described. METHODS We conducted a population based cohort study evaluating transfer to adult health services for all children (< 18 years of age) initiated on HMV in the province of Alberta over a 10-year period. Transfer to adult health services was defined as a minimum of one ambulatory encounter with an adult respirologist. Health services utilization including emergency department (ED) visits, hospital admissions and ambulatory encounters were extracted for the two years prior and three years after turning 18 years of age RESULTS Of the 729 children who were initiated on HMV, 176 reached adulthood with 3 years of follow-up (CPAP n = 123; BPAP n = 36 and; TV n = 17). Only 26% of the cohort transferred by 19 years and 42% by 21 years of age; only 8% transferred before an ED encounter. Those who transferred had a higher rate of at least one ED visit (39% vs 29%; p < 0.05) and at least one hospital admission (62.2% vs 25.1%; p < 0.001). CONCLUSION A minority of pediatric HMV users transferred to an adult respirologist by age 21 and most of those transfers occurred after an ED presentation. ED visits and hospital admission rates are high within 3 years of adulthood with decreasing use of primary care services.