Variables Correlating to Transition of Care for the Bleeding Disorder Population at the University of California San Francisco

Background An effective and coordinated process of transitioning adolescents with bleeding disorders from pediatric to adult medical care is essential for maintaining continuity of care and establishing a lifelong medical support system. Barriers to transition among people with a bleeding disorder (PWBD) at the University of California San Francisco (UCSF) are currently unknown.

Objective The purpose of this study is to collect and evaluate data on potential demographic, clinical and socioeconomic determinants of the length of time to transition among PWBD at UCSF.

Methods A retrospective chart review of 60 patients with bleeding disorders born between 1982 and 1996 was conducted to collect baseline demographic, clinical and socioeconomic data. The data was analyzed using a two-tailed t-test to determine factors associated with length of time to transition.

Results Of the 60 total patients included in this analysis, 15 were lost to follow-up. The average length of time to transition for the 45 patients who completed transition into adult care was 1.31 years, and the average age at transition was 22 years old. We analyzed various determinants of length of time to transition that fell into five categories: demographics, socioeconomic status, disease severity, level of independence and adherence to recommended care. Females trended toward a longer average time to transition of 1.93 years compared to 1.13 years for males (p=0.08). One variable had a statistically significant correlation to length of time to transition. Patients prescribed a factor product had a significantly shorter time to transition of 0.85 years compared to 2.13 years for patients not prescribed a factor product (p=0.0009). Of the 45 patients who completed transition into adult care, 62% were prescribed a factor product.

Conclusions Our study demonstrated that prescription of a factor product, which is likely an indicator of a greater disease severity, is correlated with time to transition. Our univariate analysis did not indicate that demographics, socioeconomic status, level of independence or adherence to recommended care related to length of time to transition. The results of this study are preliminary and further analysis is required to better understand the barriers to transition that exist among PWBD at UCSF.