61 - Family and provider perspectives on discharge from pediatric specialty care

Publication Number: 3058.61

Kyla Perkins, University of Maine, Bangor, ME, United States; James Bohnhoff, The Barbara Bush Children's Hospital at Maine Medical Center, Yarmouth, ME, United States; Anya Cutler, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Neil Korsen, MaineHealth Institute for Research, West Bath, ME, United States

Background: Children with complex medical conditions depend on care from pediatric subspecialists but may experience barriers to care due to workforce limitations. Prior efforts to address this issue have focused on referral processes, while less attention has been given to how and when patients are discharged once specialty care is no longer needed. Efficient discharge is critical for maintaining timely access and ensuring appropriate continuity of care.

Objective: To assess family and provider perspectives on discharge from pediatric specialty care and identify differences in expectations regarding follow-up management and primary care transitions.

Design/Methods: In summer 2025, we conducted paired surveys of pediatric specialists and their patient families following pulmonology and gastroenterology visits at an academic medical center in the Northeast United States. Families refers to responses provided by parents for younger children and by patients themselves for older children and adolescents. Surveys assessed expectations for subsequent care and comfort with a hypothetical transition of management to primary care. Patient records were reviewed for visit diagnoses. We performed analyses for the overall population and among children seen for constipation and asthma, as these are common conditions often managed by primary care providers (PCP). Proportion tests were used to compare patient and provider responses.

Results: Among 147 participants, 132 visits were included in the final analysis: 53 pulmonology visits, (41 for an asthma diagnosis) and 79 gastroenterology visits (14 for a constipation diagnosis). In 20 (14%) visits, both families and providers anticipated no follow-up visits. Families and providers differed significantly in anticipated outcomes of specialist care (p=0.001), with providers anticipating eventual discharge to PCPs for 67 (55%) patients, while families only anticipated this for 37 (30%) patients (Table 2). Families and providers also differed significantly when asked whether a PCP could manage care if the patient were discharged today (p < 0.0001), with 44% of families agreeing compared to 62% of providers (Table 3). Results for individual specialties and diagnoses are included in Tables 1-3.

Conclusion(s): Families reported lower comfort and confidence with discharge from pediatric specialty care than providers. These findings suggest a need for improved communication and clearer expectations regarding the duration and goals of specialty care. Future work should explore family and PCP perspectives qualitatively to inform interventions that support timely and coordinated discharge planning.

Table 1: Proportion of patient families and specialists anticipating an additional visit.
Proportion of patient families and providers who anticipated a follow-up visit with the specialty. Families and providers generally demonstrated concordance, with most patients expected to return for follow-up care.

Table 2. Patient family and specialist expectations regarding eventual outcomes of specialist care.
Proportion of patient families and providers reporting their anticipations regarding long-term management of care. Compared to providers, families were more likely to expect either ongoing specialty involvement or complete resolution within specialty care, whereas providers most often anticipated eventual transfer of care to a primary care provider. Families and providers demonstrated concordance less than half of the time.

Table 3. Patient family and specialist confidence in PCP management in the event of a hypothetical discharge from specialist care.
Proportion of patient families who reported confidence that a primary care provider (PCP) could manage the patient's care in the event of an immediate discharge from specialty care. Across all specialties, providers were more likely than families to express confidence in PCP management.