a central database was created in august 2002 for two cohorts of participants in the maestro project : 1 ) a younger group ( aged 18 years , n = 84 ) who had the assistance of the navigator as they graduated from pediatric care and 2 ) an older group ( aged 1925 years , n = 64 ) who were transferred to adult care without this initial support . they were later enrolled in the program , 17 years after graduation from pediatric care . the maestro collected information from the participants by telephone every 6 months regarding medical or diabetes education visits , the presence of chronic complications , diabetes - related hospitalizations for diabetic ketoacidosis ( dka ) or severe hypoglycemia , and barriers to accessing care in the adult diabetes care system . evaluation was completed from september to december 2004 for the year before the maestro project was created and for the year after the maestro project was in place . sources of data included database review , audit of medical records , and a qualitative participant survey . the number of medical and diabetes educator visits was available for the year before and year after referral to the maestro project for 101 of 164 patients ( 62% ) in the older group and 64 of 84 patients ( 76% ) in the younger group . as seen in table 1 , the systems navigator model helped the older group reconnect with adult medical services and helped the younger group reduce their first year fall - out rate after transfer from pediatric to adult care . prior to intervention from the navigator , over 40% of this fall - out rate was lower in the younger group , who had access to the navigator at the time of transfer from pediatric care ; only 11% of this younger group dropped out of adult medical care completely after transfer . the older group reported pregnancy loss of 38% ; 1 case each of heart failure , legal blindness , and amputation ; 4 cases of proliferative diabetic retinopathy ; 4 deaths ( 2 from dka and 2 unrelated to diabetes ) . both groups reported acute complications requiring visits to the emergency room or admission to a hospital . for dka , there were 3.0 cases per 100 patient - years in the older group versus 7.9 cases per 100 patient - years in the younger group ( ns ) . for severe hypoglycemia , there were 2.4 cases per 100 patient - years in the older group versus 4.7 cases per 100 patient - years in the younger group ( ns ) . of the participants , 33% of the younger group and 42% of the older group experienced difficulties or frustrations with establishing regular follow - up with their adult health care team after transfer from pediatric care . reasons for dropping out of care included difficulty scheduling appointments and knowing who to see , difficulty establishing relationships with the new team , feeling overwhelmed and lost in the system , and a lack of perceived value of adult care . of the participants , 100% of the older group and 78% of the younger group felt that there was a need for the maestro project . the maestro project had facilitated 374 referrals for 168 participants to endocrinologists , diabetes educators , mental health professionals , and eye specialists , and 198 individual participants had contacted the maestro project 515 times for information . at the time of transfer from pediatric to adult care , many young adults are unable to independently navigate the adult diabetes care system . the young adults who are enrolled in a systems navigator and support program before age 18 years are better connected to the adult health care system than those who graduated before the program existed . in the first 2 years of the maestro project , there was improved medical surveillance but no evidence of improved short - term medical outcomes . this may be due to specific characteristics of this young adult cohort , specific characteristics of service delivery in the adult care system , or inadequate development or time for optimum evaluation of this model .
objectives to determine whether a systems navigator service , the maestro project , could increase medical surveillance for young adults with type 1 diabetes who transfer from pediatric to adult care.research design and methods there were two cohorts of participants : 1 ) a younger group ( aged 18 years , n = 82 ) who had the assistance of the navigator as they graduated from pediatric care and 2 ) an older group ( aged 1925 years ) who were transferred to adult care without this initial support but later enrolled in the program.results of the older group ( who did not have initial access to the navigator ) , 40% dropped out of adult medical care , compared with a dropout rate of 11% for the younger group , who had access to the navigator at the time of transfer from pediatric care.conclusions the systems navigator helped improve medical surveillance for both groups , although there was no evidence of improved short - term medical outcomes .