Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.