Compassionate Care and Organization of Healthcare Services for a Successful Transition in Rheumatology

The transition from pediatric to adult healthcare services represents a vulnerable period for adolescents and young adults with chronic inflammatory rheumatic diseases (CIRD). This phase is associated with increased risks of poor treatment adherence, disruption of follow-up, and adverse disease outcomes. While structured transition programs have been shown to improve patient autonomy and continuity of care, evidence in rheumatology remains limited, particularly regarding real-life effectiveness after transfer to adult care.

At Bicêtre University Hospital (AP-HP, France), a structured transition program has been progressively implemented since 2018 in collaboration with adult rheumatology and internal medicine departments. This program includes early transition information, progressive empowerment, a therapeutic patient education (TPE) workshop (MIRAJE program), and a joint pediatric-adult transition consultation. In parallel, some patients benefit from additional educational and administrative support provided by the RESRIP network after transition.

The BOOST-R study is a monocentric, observational, non-interventional study conducted in the pediatric rheumatology department of Bicêtre University Hospital. Adult patients with a diagnosis of CIRD who were followed in pediatric rheumatology and participated in a joint pediatric-adult transition consultation between 2018 and 2024 are eligible. Patients are contacted by postal mail and invited to complete an online questionnaire after receiving study information and having the opportunity to express non-opposition.

The primary outcome is transition readiness assessed using the French validated 20-item Transition Readiness Assessment Questionnaire (TRAQ-FR). The primary analysis compares the mean total TRAQ-FR score between patients who benefited from a TPE workshop plus a transition consultation and those who received a transition consultation only. Higher TRAQ-FR scores indicate better self-management and readiness for adult care.

Secondary outcomes include indicators of continuity of care after transition, such as number of adult care visits, delay to first adult visit, treatment adherence, and disease flares. Additional analyses will explore demographic, clinical, social, and educational factors associated with successful transition, evaluate the impact of support by the RESRIP network, and describe patients who did not benefit from structured transition interventions.

Statistical analyses will include descriptive analyses and multivariable regression models adjusted for relevant confounders, including age, sex, underlying disease, socio-professional status, and time since transition. Sensitivity analyses using propensity score methods will be performed to account for the non-randomized design.

The study involves no intervention and no additional risk for participants. Data are collected and managed in accordance with applicable French and European data protection regulations.

Inclusion criteria

• Age 18 years or older
• Diagnosis of chronic inflammatory rheumatic disease
• Previously followed in pediatric rheumatology at Bicêtre Hospital
• Participation in a joint pediatric-adult transition consultation between 2018 and 2024
• Affiliated with a health insurance system
• No objection expressed to participation after being informed about the study

Exclusion criteria

• Patient lost to follow-up
• No participation in a joint pediatric-adult transition consultation
• Patient under guardianship, curatorship, or legal protection