river hills community health center pediatrician focus group

Supporting the Transition from Pediatric to Adult Health Care

Rachel Nash, BS, MPH Candidate | IOWA PCA

What & Why TRANSITIONING?

• Definition of Health Care Transition: The purposeful, planned and timely transition from child and family-centered pediatric health care to patient-centered adult-oriented health care. (Society for Adolescent Medicine, 1993)

• The goal of a planned health care transition is to maximize lifelong functioning and well-being for all youth, including those who have special health care needs.

• Only about 50 percent of parents report discussing their adolescents’ changing health care needs with a pediatrician, and of those only 42 percent had discussed switching to an adult provider. (Pediatrics, 2009)

• Identified as a need by IPCA and RH staff

• A comprehensive and coordinated transition to adult care makes for better outcomes for children and young adults

• Early education about transitioning helps youth feel more comfortable with taking on new responsibilities and more empowered when it comes to their own health

• Successful transitions can help prevent readmissions to the hospital in young adulthood (18-24)

• Transitioning to another RH provider helps with continuity of care and keeps children in one system

What & Why TRANSITIONING?

AAP Clinical Report (2011)

MY PROJECT• Part 1: Quality Improvement Initiative

– Patient Centered Medical Home Designation• 5C: Coordinate With Facilities and Care Transitions • “Collaborates with the patient/family to develop a written

care plan for patients transitioning from pediatric care to adult care”

– Pilot at River Hills Community Health Center (Pediatric Clinic)

• Part 2: Develop Transitioning Toolkit – to be used by providers at all community health centers across Iowa

Transition of Care Checkbox

*On Initial Intake form, Care Management Plan form, and Pediatric CC/HPI form**Currently shows up at age 16 – working to change it so checkbox appears at age 12

Adolescent Transition of Care Form

• Added to two office visit types:– PEDS Chronic– PEDS Well-Child (+1 year) – Physicals

• 14 Yes/No Questions broken down into three age ranges

• 3 Domains– Increasing Adolescent Responsibility for

Healthcare Management – Readiness Assessment for Transfer to Adult Care – Implementation of Transfer to Adult Care

• Gradually complete questions as child moves through adolescence

Adolescent Transition of Care Form

Patient Medical Record

HCT Index – Provider Survey

Other Transition Toolkits

• http://newenglandconsortium.org/for-families/transition-toolkit/

• http://rwjms.rutgers.edu/boggscenter/products/BeingaHealthyAdultHowtoAdvocateforYourHealthandHealthCare.html

• http://healthytransitionsny.org/skills_media/tool_show

Discussion• What are you already doing in your clinical

practice to support this transition period? How do you think it could be improved?

• How do you think parents will respond to these questions being asked?

• How do you think adolescents will respond to these questions?

• What educational materials might you need to supplement these discussion?

THANK YOU!

References

• Lotstein, Debra S., et al. "Planning for health care transitions: results from the 2005–2006 national survey of children with special health care needs." Pediatrics 123.1 (2009): e145-e152.

• Cooley, W. Carl, and Paul J. Sagerman. "Supporting the health care transition from adolescence to adulthood in the medical home." Pediatrics 128.1 (2011): 182-200.