Class of 2015 Abstract / Objectives: The primary objective of the study was to evaluate for change in vitamin D levels and regimens in cystic fibrosis (CF) patients following implementation of the 2012 Cystic Fibrosis Foundation (CFF) vitamin D guidelines. Secondary endpoints included clinician adherence to guideline recommendations for treatment and management of vitamin D deficiency. Methods: This retrospective chart review included CF patients with 25-hydroxy vitamin D (25(OH)D) levels from University of Arizona Medical Center (UAMC) between April 1, 2011-March 31, 2012 and July 1, 2012-June 30, 2013. Total 25(OH)D levels and vitamin D regimens were collected along with data on respiratory cultures, pulmonary function, and hospitalizations. Data were analyzed by Student’s T-tests and chi square analyses. Results: A total of 62 patients were included in the study. Mean 25(OH)D levels did not significantly differ between the study periods (28.9±10.5 ng/mL pre-guideline and 27.0±9.1 ng/mL post-guideline, p=0.158). Cholecalciferol use increased post-guideline (57.1%) versus pre-guideline (75.8%, p=0.027). Post-guideline cholecalciferol doses increased to 2836.5±2669.4 international units [IU] daily compared to 1518.0±912.0 IU daily pre-guideline (p<0.001). Clinician adherence to dose titration recommendations resulted in significant 25(OH)D level elevations (28.3±8.9 ng/mL versus 24.7±9.0, p=0.047). Conclusions: The prescribing pattern of clinicians significantly changed to reflect vitamin D regimens suggested by CFF guidelines. This finding suggests that had sufficient time been allowed following guideline implementation, a significant difference in 25(OH)D levels would have resulted. Additional research is needed concerning the effect of the guidelines on vitamin D status, clinical outcomes, and comorbidities.

The aim of this dissertation is to explore experiences and describe outcomes of healthcare transition in cystic fibrosis (CF). Chapter one introduces the central concepts of this dissertation, describes current gaps in the literature on healthcare transition in cystic fibrosis and introduces the Expanded Socioecological Model for Adolescent and Young Adult Readiness for Transition (Expanded SMART), which guides the three studies of this dissertation. Chapter two is a qualitative meta-synthesis of 63 studies describing adolescent, young adult, and parent experiences of healthcare transition across a variety of chronic conditions. Chapter three is a qualitative study exploring perceptions of CF management responsibility among a sample of 15 adolescent with CF and parent dyads. Chapter four uses national Cystic Fibrosis Foundation Patient Registry data to examine healthcare transition outcomes associated with participation in the transition preparation program CF R.I.S.E. Chapter five synthesizes the three studies of this dissertation and provides recommendations for practice, policy, and research.