对患有多种慢性病的儿童癌症幸存者的连续性和协调性护理尚未得到充分研究，但对于适当的后续护理至关重要。从 2022 年 4 月到 6 月，800 名患有两种或多种慢性病（一种或多种严重/危及生命/致残）通过电子邮件收到了“患者感知的多位临床医生的持续护理”调查。该调查询问了幸存者的主要（照顾大部分医疗保健）和协调（确保后续）提供者，产生了三个护理协调总结分数（主要提供者、跨多个提供者、患者与提供者的伙伴关系），并包括六个不连续性指标（例如，必须组织自己的护理）。不连续性（是/否）被定义为对一个或多个不连续性项目护理不善。卡方检验评估了不连续性与社会人口统计学之间的关联。修改后的泊松回归模型估计了与专业和看诊主要提供者和协调提供者的年数相关的不连续风险的患病率 (PR)，以及与三个护理协调总结措施的更好得分相关的 PR。根据调查不参与情况调整逆概率权重。共有 377 名幸存者 (47%) 做出回应（平均年龄 48 岁，68% 女性，89% 非西班牙裔白人，78% 有私人保险，74% ≥大学毕业生）； 147/373 (39%) 报告不连续。年轻的幸存者更有可能报告不连续性（卡方 p = .02）。与主要医疗服务提供者见面的时间≤3 年与更普遍的不连续性相关（PR；95%CI）（1.17；1.02-1.34 vs ≥ 10 年）。癌症专科主要提供者与不连续性的发生率较低（0.81；与初级保健相比为 0.66-0.99）。所有三项护理协调总结指标的得分较高与不连续性较少相关：主要提供者（0.73；0.64-0.83）、跨多个提供者（0.81；0.78-0.83）、患者-提供者伙伴关系（0.85；0.80-0.89）。儿童癌症幸存者中护理中断的现象普遍存在，需要干预。© 2024 美国癌症协会。

Continuity and coordination-of-care for childhood cancer survivors with multiple chronic conditions are understudied but critical for appropriate follow-up care.From April through June 2022, 800 Childhood Cancer Survivor Study participants with two or more chronic conditions (one or more severe/life-threatening/disabling) were emailed the "Patient Perceived Continuity-of-Care from Multiple Clinicians" survey. The survey asked about survivors' main (takes care of most health care) and coordinating (ensures follow-up) provider, produced three care-coordination summary scores (main provider, across multiple providers, patient-provider partnership), and included six discontinuity indicators (e.g., having to organize own care). Discontinuity (yes/no) was defined as poor care on one or more discontinuity item. Chi-square tests assessed associations between discontinuity and sociodemographics. Modified Poisson regression models estimated prevalence ratios (PRs) for discontinuity risk associated with the specialty and number of years seeing the main and coordinating provider, and PRs associated with better scores on the three care-coordination summary measures. Inverse probability weights adjusted for survey non-participation.A total of 377 (47%) survivors responded (mean age 48 years, 68% female, 89% non-Hispanic White, 78% privately insured, 74% ≥college graduate); 147/373 (39%) reported discontinuity. Younger survivors were more likely to report discontinuity (chi-square p = .02). Seeing the main provider ≤3 years was associated with more prevalent discontinuity (PR; 95%CI) (1.17; 1.02-1.34 vs ≥ 10 years). Cancer specialist main providers were associated with less prevalent discontinuity (0.81; 0.66-0.99 vs. primary care). Better scores on all three care-coordination summary measures were associated with less prevalent discontinuity: main provider (0.73; 0.64-0.83), across multiple providers (0.81; 0.78-0.83), patient-provider partnership (0.85; 0.80-0.89).Care discontinuity among childhood cancer survivors is prevalent and requires intervention.© 2024 American Cancer Society.