O-014 YI Transition of IBD Care: Assessment of Transition Readiness Factors and Disease Outcomes in a Young Adult Population

The incidence of Inflammatory Bowel Disease (IBD) in the pediatric age group is increasing. As there is a growing cohort of patients that will eventually move from pediatric to adult care, both pediatric and adult gastroenterologists need to be aware of issues specific to adolescents. Patients may become lost to follow up during the transition from pediatric to adult care, and it is known that medication and visit non-adherence is common during this time. The purpose of this study is to assess transition readiness in a population of young adult patients, and to identify patient-related factors that are predictive of successful transition as defined by disease control and follow up. IBD patients, ages 18 to 25, followed at the Mount Sinai Medical Center were surveyed at the time of an outpatient visit with either a pediatric or adult gastroenterologist. The survey included validated methods to assess transition readiness (Transition Readiness Assessment Questionnaire or TRAQ 3.0), socioeconomic status (Hollingshead criteria), and mental health (Mental Health Inventory-38), as well as questions regarding the patient’s own transition experience. In a preliminary analysis 77 patients were surveyed, 35 (45%) of which had been seen by an adult gastroenterologist and 42 (55%) by a pediatric gastroenterologist. Average age at time of survey completion was 21.6 and average age at time of IBD diagnosis was 15.1 (range 3.6–22.4 years). Fifty-three subjects (69%) had Crohn’s disease, 20 (26%) had ulcerative colitis, and 4 (5%) had indeterminate colitis. Average TRAQ 3.0 self-management score was 3.6 ± 0.11 (range 1–5) in the adult population and 2.9 ± 0.87 in the pediatric population. Average TRAQ self-advocacy score was 4.1 ± 0.43 (range 1–5) in the adult population and 3.9 ± 0.7 in the pediatric patients. Eleven adult patients were not included in transition analysis because they had never been followed by a pediatric gastroenterologist. Of the remaining 24 patients already followed by an adult gastroenterologist, 14 (58%) reported that their pediatric gastroenterologist had discussed transition with them and were given the name of adult gastroenterologist to contact, while 10 (42%) reported that transition had not been discussed. In the pediatric population, 21 (50%) reported that their pediatric gastroenterologist had already discussed transition, while 21 (50%) had not, and only 2 patients (4.7%) were already given the name of someone to contact. In the adult population, all patients identified themselves as ready to transition, while only 17 (40%) of pediatric patients identified themselves as “definitely ready” or “probably ready” to transition. Transition is not being universally discussed by pediatric gastroenterologists, and many young adults do not identify themselves as being ready to transition. Enrolled patients are currently being followed prospectively over a 3 to 6 month period to assess disease activity as measured by ED visits, hospitalizations for IBD, changes in inflammatory markers, and compliance with follow up visits. By identifying early predictors of transition success, we can work towards establishing a transition program that meets the needs of all IBD patients.