64 Evaluating Outcomes of Transition From Pediatric to Adult Care in Patients With Inflammatory Bowel Disease: A Retrospective Cohort Study Using the TriNetX Data Network

Background: The transition from pediatric to adult care in patients with inflammatory bowel disease (IBD) is a vulnerable period associated with disease flares, gaps in continuity of care, and suboptimal health outcomes. These are largely thought to be associated with differences in care models, patient overall readiness for transition, and the complexity of self-management required in adult healthcare systems. Structured transition programs, including joint clinics and multidisciplinary approaches, are associated with improved clinical outcomes; however, practices vary and no standardized model currently exists. Despite the recognized importance of this topic, large-scale data evaluating outcomes during this transition remain limited. This study aims to compare clinical outcomes in young adults (age 18–25) who completed transition to a new provider to those who did not. Methods: We performed a retrospective cohort study using the TriNetX Data Network, first identifying patients diagnosed with IBD before age 18. Subjects were then stratified into 2 cohorts based on presence or absence of new clinical encounters for IBD between age 18 and 25, reflecting transition to adult care. Cohort comparisons were evaluated for post-transition outcomes including: hospitalizations, emergency department visits, corticosteroid use, IBD-related complications (fistulizing disease, perianal abscess, intestinal resection, and c. diff infection), disease severity (CRP and fecal calprotectin), and psychiatric comorbidities (anxiety, mood, and behavioral disorders). We also evaluated and compared medical therapies utilized between cohorts. Results: After 1:1 propensity score matching, 2,430 patients were included in the 2 cohorts. Patients who transitioned to a new provider during the age of 18–25 had significantly higher odds of ED visits and hospitalizations. Additionally patients who transitioned to a new provider had higher odds of corticosteroid use, IBD-related complications, and psychiatric comorbidities. Interestingly disease severity as measured with CRP and fecal calprotectin was not significantly different using t-test for mean differences. Utilization of medical therapies differed between the 2 groups, with significant variation in most biologic agents, except for infliximab and adalimumab, which showed no significant difference in use. Conclusions: In patients with established IBD diagnosed < 18 years old, a new provider encounter during age 18–25 likely correlates with a transition from a pediatric to adult provider. Transition is associated with increased risk of ED visits, hospitalization, corticosteroid use, IBD-related complications, and psychiatric comorbidities. These findings suggest that the transition from pediatric to adult care in patients with IBD is associated with increased healthcare utilization and adverse disease-related outcomes, despite comparable objective markers of disease activity. This discrepancy may reflect challenges inherent to the transition process, including disruptions in continuity of care, reduced adherence to treatment, and psychosocial stressors. These factors can lead to increased reliance on acute care services and higher rates of complications, even in the absence of measurable increases in inflammatory activity. This highlights the need for targeted interventions during the transition period to optimize continuity of care and improve long-term outcomes in this patient population.