Background: The first years of transition from pediatric to adult care are associated with an increased mortality in select disease states . While transitioning the outpatient care of children into adult care is well-established [2-4], there is no data on how to best transition young adults in the inpatient setting . The first experience of a young adult with the adult health system may be a hospitalization. If the experience is poor, they may be less likely to appropriately access and adhere to care. As an initial step in developing a young adult hospital medicine service, we sought to identify thematic gaps in the care of hospitalized young adults.
Methods: An informal focus group of five internal medicine and pediatrics (med-peds) trained hospitalists, the chief of med-peds and the chief of hospital medicine was assembled to identify differences in care between specialized children’s hospitals and adult hospitals. Based on themes generated in the focus group, five med-peds hospitalists performed a structured chart review of 25 patients aged 18-25 admitted to Parkland Memorial Hospital from January 1, 2019 to July 31, 2019. Demographics were extracted as well as primary and secondary diagnoses, consultant and family involvement, follow up plans, funding, and any other perceived gaps or disparities in care.
Results: The most common primary admitting diagnoses were DKA, pyelonephritis and sickle cell pain crisis. Patients were either Hispanic or African American. Patient funding sources were private, government assistance, charity, unfunded or jail. (Table 1) The thematic gaps in care included decreased subspecialist involvement, decreased family involvement, less robust case management and care coordination, different clinical care processes and less attention to and support for emotional needs. (Table 2) Patient experience was also only rarely documented. Two patients admitted were noted to have significant anxiety and fear around their diagnosis and management. For clinical care, one patient with sickle cell expressed significantly worse pain than previous admissions at the Children’s hospital, stating that he usually had a PCA and was only on as needed IV pain meds (Table 2 for further examples). 75% of DKA admissions identified had been admitted >2 times in the past year. 100% of the sickle cell pain crisis admissions noted had >2 admissions in the past year, as well as multiple ED visits not resulting in an admission. 44% of patients were noted to have missed follow-up appointments although 92% of patients had follow-up appointments scheduled at the time of discharge.
Conclusions: Our initial, proof of concept, investigation into opportunities for a young adult hospital medicine service provides valuable insight into how such a service might benefit hospitalized young adults. We found an expectation mismatch in clinical care, emotional support, subspecialty and family involvement, and care coordination in patients with pediatric onset health conditions. Our initial data suggests that patients with pediatric onset special health care needs transitioning into the adult acute care system could derive significant benefit from a service staffed by physicians and other healthcare specialists with specific knowledge about the clinical, social, emotional and care coordination needs of young adults.