faculty disclosure information - aap chapter 3
TRANSCRIPT
10/1/2012
1
Internists' Perspective on Transition of Youth/Young Adults with and without Special
Health Care Needs to Adult Health CareOctober 3, 2012
Patience White, MD, MAVice President, Public HealthArthritis FoundationProfessor of Pediatrics and MedicineGeorge Washington UniversitySchool of Medicine and Health Sciences
Faculty Disclosure Information
• In the past 12 months, I have had no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.
• I do not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation.
Case Study Learning Objectives
• Define health care transition and the key role internists play in the process
• List the elements of the AAP/ACP/AAFP clinical report on practice-based implementation of transition planning for all youth/young adults with particular focus on those youth over age 18
• Discuss DC Learning Collaborative process from the internal medicine perspective and report the outcome for internal medicine practices
• Identify quality improvement opportunities for an adult focused practice around the transition of youth/young adults to adult medical care
What are Health Care Transitions?Transition is facilitating seamless processes across health care facilities and between practicesoutlining key procedures for the following areas: • From Hospitals, Emergency Departments, and other
Health Care Facilities to Home …• To/from Hospitals, Emergency Departments, and
other Health Care Facilities to/from Home/Ambulatory Care Office…
• To/From primary care to specialty care• From Pediatric to Adult Health Care
settings
What is Pediatric to Adult Health Care Transition?
Transition is the deliberate process of moving seamlessly from child-oriented health care to adult-oriented health care.Components:• Self-Determination• Person-Centered Planning• Prep/transfer for/to
Adult Health Care• Work/Independence • Inclusion in Community Life• Longitudinal experience including transfer
10/1/2012
2
The Transition Process
Transfer of Care
Pediatric Care Adult Care
Transition
SOURCE: Rosen DS. Grand Rounds: all grown up and nowhere to go: transition from pediatric to adult health care for adolescents with chronic conditions.
Presented at: Children’s Hospital of Philadelphia; 2003; Philadelphia, PA
Institute of Medicine QUALITY MEASURES Health Care Processes Should Have:
• Care based on continuing healing relationships
• Customization based on patient needs and values
• Patient as source of control
• Shared knowledge and free flow of information
• Safety
• Transparency
• Anticipation of needs
SOURCE: Crossing the Quality Chasm 2001
Who Are CYSHCN?
“ Children and youth with special health care needs (CYSHCN) are those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”
Source: McPherson, M., et al. (1998). A New Definition of Children with Special Health Care Needs. Pediatrics. 102 (1); 137-139.
Prevalence of CSHCN NY US
CSHCN Prevalence
Percent of children who have special health care needs
15.0% 15.1%
CSHCN Prevalence by Age
Age 12-17 years 17.9 18.4
CSHCN Prevalence by Sex
Male 17.2 17.4
Female 12.5 12.7
CSHCN Prevalence by Poverty Level
0-99% FPL 16.7 16.0
100-199% FPL 14.8 15.4
200-399% FPL 13.5 14.5
400% FPL or more 14.8 14.7
NY US
CSHCN Prevalence by Hispanic Origin and Race
Non-Hispanic 15.3 16.2
White 15.5 16.3
Black 17.2 17.5
Other 10.5 13.6
Hispanic 13.2 11.2
Spanish Language Household 19.7 8.2
English Language Household 7.4 14.4
Prevalence of CSHCN: NY vs. US
Prevalence U.S. (%)Proportion of Youth with Special Health Care Needs, Ages 12-17
18.4%(4,581,950)
Proportion of YSHCN with functional limitations 24
Proportion of YSHCN with 2 or more chronic conditions 62
Proportion of YSHCN with emotional, behavioral, or developmental conditions
64
Source: National Survey of Children with Special health Care Needs, 2009/10
How Many Youth Need Transition Services?Scope of The Problem
• 90+% of children with chronic conditions live beyond age 20 years
• Approximately 500,000 youth with special health care needs will turn 18 each year
• Transition from pediatric to adult medical care is a high-risk period for morbidity and mortality
• Cultural challenges due to different practice approaches between pediatric and adult medical care-youth/young adults/families find it difficult to navigate and cope with the gaps
Van der Lee J, etal JAMA 2007;297(24):2741-51
10/1/2012
3
Difference Between Systems
Pediatric Adult
Age-related Growth, development and future focused
Maintenance/decline; optimize the present
Focus Family IndividualApproach Proactive, paternalistic Reactive, collaborative
Shared decision-making With family/parent With patient who is a self-advocate
Insurance/services Entitlement Qualify/eligible
Non-adherence More assistance More tolerance
Procedural Pain Lower threshold Higher threshold # of patients Fewer Greater
Multiple Transitions for YouthAges 12-24
• Adult body
• Mature (abstract) cognitive style
• Separate from family/leave family home
• Sustained peer relationships
• Intimate relationships
• Increasing autonomy…. Interdependence
• Define a productive adult role
New York TimesArticle
Sept 5, 2011When Adult Children Come Home to Roostby Michelle Singleterry
Questions About Your Transition
• What do you remember about your adolescent/young adult years and health care-when did you leave your pediatrician and move to an adult health care provider?
• Was your health care continuous or was there a gap?
• Did you leave actively (plan your transfer to an adult HCP) or passively?
WHAT DO DATA TELL US?
What do youth/young adults say they want in transition?
Youth With Disabilities:Stated Needs for Success in Adulthood
PRIORITIES:
1. Making $$$-Career/job development
2. Independent living skills
3. Finding quality medical care-what to do in an emergency
4. Legal rights
5. Protect themselves from crime
6. Obtain financing for school
Source: Point of Departure, a PACER Center Publication Fall, 1996
10/1/2012
4
WHAT DO DATA TELL US?
What proportion of parents report receiving adequate transition support for their YSHCN?
Proportion of Youth with Special Needs Who Receive Services
Needed to Make Transition to Adult Health Care
U.S. (%)Total YSHCN meeting transition measure
40%(1,708,799)
GenderMale 37Female 44
Race/EthnicityBlack 28White 46Hispanic 25
InsurancePrivate insurance only 50Public insurance only 26Uninsured 20
Presence of a medical homeWith a medical home 55Without a medical home 29
NA = sample size too small for reliable estimates.
Source: NS-CSHCN 2009/2010
Adolescents Meeting Transition Outcomes: NY and US
Performance on Core Transfer Outcomes NY US
Overall Performance 40% 40%
Gender
MaleFemale
3743
3744
Medical Home
With Without
6324
5529
WHAT DO DATA TELL US?
How prepared are youth for managing their care in the adult health care system?
Pediatric HCP report what they do for youth around transitioning to an adult provider *
• 47% assist youth with referral to adult physician • 27% create portable medical record• 23% offer consultative support to family or internal
medicine physicians• 80% find it difficult to break the bond with
youth/family• 84% of youth/young adults lack knowledge about
condition• 33% of pediatricians discuss consent and
confidentially issues before 18• 12% of pediatricians create Individual transition plan
* AAP Periodic Survey 2008
Internal Medicine Nephrologists (n=35)Survey Components Percentages
Percent of transitioned patients < 2% in 95% of practices
Transitioned patients came with an introduction 75%Transitioned patients know their meds 45%Transitioned patients know their disease 30%Transitioned patients ask questions 20%Parents of transitioned patients ask questions 69%Transitioned adults believed they had a difficult transition 40%
Source: Maria Ferris, MD, PhD, MPH, UNC Kidney Center 2011
10/1/2012
5
What do adult physicians say they need to assist YSHCN?
WHAT DO DATA TELL US?
Internists’ and Pediatricians’ Comfort with Caring for YSHCN
• 53% of Peds and IM responded to questionnaire (1228 responses)
• IM more comfortable than Peds in caring for 17-25 yowith HBP, DM, Depression, chronic pain
• Most IM not comfortable caring for CF, SCD and 50% thought specialists should provide primary care
• IM comfort related to training and experience not availability of specialists or ancillary care such as SW
Okumura 2009
Internists’ Perspectives on Transition
• Internists random selected from 2000 Am Board Med Specialities-67/134 eligible
• Top Score of barriers:– Not have training/need guidance in congenital and ped chronic illness,
adol health/dev/behavior– Guardianship issues need to be clarified: Want family engaged when
youth unable to be their own health decision maker– Youth less mature (less ready for decision making ability/increased
adherence issues)– Family/pediatrician reluctant to relinquish responsibility for care– Transition from pediatric practices not coordinated– Need to facilitate sub specialists from peds and adult (lack of adult
subspecialists for pediatric illnesses )– Difficulty face end of life issues early in relationship/early in life– Barriers-finances (lack of insurance for young adults), infrastructure, staff
training, lack of local services
Thompson et al, Pediatrics 2/09
Survey of Adult Health Care Providers in NH 2008: Results
• Who:180 responses: 81% Fam, 9% internist, 8% NP, 2% Med-peds
• Communication:– 57-46% rarely/never received trans summary or call – 48% young adult experienced care gap
• Barriers: time, staffing, reimbursement issues inadequate support from specialists
• Comfort Level:– More- asthma, inc BP, Mental health, DM– Less- CF, Chromosome/met disorders, autism, technology dep
• What would Help:– 95% written summary and support from specialists, – 91% want to speak w prior provider, – 84% written educational info about condition– Clarify guardianship issues
• When Transfer: 78% between 18-21 years
What to do? Where to start?
Health Care Transition ServicesIn the past and currently…• Medical transition services provided by:
– patchwork of pediatric clinics mostly in university subspecialty setting – less common to have transition services in primary care setting– Med-Peds physicians seen as logical providers of transition care services but few
available
• National data reveal little progress made in transition from pediatric to adult health care in last decade despite a 2002 Consensus statement by AAP/ACP/AAFP including identifying core transition knowledge and skills and recommending transition plans
• Literature reviews reveal inconclusive evidence regarding role of transition programs to facilitate transition. Only evidence for improved outcomes suggests meeting adult providers before transfer improves post transfer access and quality of care (Bloom 2012)
• Surveys of pediatricians, family physicians and internists point out the need for more information and support re: transition
10/1/2012
6
New Health Care Transition Clinical Reportbackground
• 2 years ago, AAP/ACP/AAFP appointed a Transition Authoring Group to develop a clinical report based on data and clinical practice
• Clinical Report: Provides practical, detailed guidance (including a step-by-
step algorithm) on how to plan and implement better health care transitions for all patients
Integrates transition planning into the medical home and ongoing chronic care management
Provides guidance for financial support of HCT• Publication: “Supporting the Health Care Transition from
Adolescence to Adulthood in the Medical Home” (Pediatrics, July 2011) – clinical report jointly authored by the AAP, the AAFP, and the ACP
Health Care Transition Clinical Report
• Targets all youth, beginning at age 12 and links the process to the medical home
• Algorithmic structure provides logical frameworkBranching for youth with special health care needsApplication for primary and specialty practices serving
children and adults with variety of conditions Structure for training, continuing education, & research
• Provides explicit practice-based guidance for planning, decision making, and documentation processes
• Extends through the transfer of care to an adult medical home and adult specialists
Pediatric Health Care Transition Milestones (transition visits from the algorithm)
• Age 12 – Youth and family aware of the practice’s health care transition and transfer policy
• Age 14 – Health care transition planning initiated
• Age 16 – Discussion of youth and parental expectations and preferences regarding adult health care
• Age 18 – Transition to adult model of care even if remain in a pediatric setting before moving to adult model of care (appropriate guardianship issues addressed for cognitive ability)
• Age 18-22 – Transfer of care to adult medical home and specialists with privacy policies , self management skills assessments and education
National Health Care Transition Center • MCHB-funded resource center, GotTransition.org
• Responsible for developing transition tools aligned with clinical report and fostering practice changes
• Use of Learning Collaborative (LC) methodology used by the National Initiative for Children’s Healthcare Quality (NICHQ) and pioneered by the Institute for Healthcare Improvement (IHI). Primary care expert panel in DC led the way developing
o LC charter oThe 6 core HCT elements based on the algorithm oTransition tools oHCT index for evaluation
LCs in DC, Denver, Boston, NH
For more information: www.GotTransition.org
10/1/2012
7
Methodology: Evidence for Learning Collaboratives
• Learning collaboratives (LCs) – Shown to improve several aspects of health care – Effective method of improving the quality of care delivered by pediatric
and adult practices
• Collaborative teams have achieved dramatic results, including:– Reducing wait times by 50%– Reducing worker absenteeism by 25%– Reducing ICU costs by 25%– Reducing hospitalizations for patients with CHF by 50%
Transition Intervention: 6 Core Elements For Practice Transformation
Pediatric Health Adult Health
1. Transition Policy 1. Privacy and Consent Policy (adult model of care)
2. Transitioning Youth Registry 2. Young Adult Patient Registry
3. Transition Preparation (skills checklist, port. medical summary, fact sheet)
3. Transition Preparation (follow up on skills checklist, update port. medical summary)
4. Transition Planning (create HCT plan) 4. Transition Planning (complete HCT Plan)
5. Transition and Transfer of Care(check list, shared care with adult provider for period of time)
5. Transition and Transfer of Care(checklist, shared care with pediatric provider as consultant)
6. Transition Completion 6. Transition Completion
Designing a LC for Health Care Transition
• Unique featuresDyads of pediatric and adult practices Involvement of care coordinatorsConsumer involvementWorking across organizations and
systems to improve care
• Design and timelinesTeaching and learning strategies Incorporate elements to fit each
practice’s processesPractice, accountability, shared learning
DC as a National Transition Model: Learning Collaborative Teams
Howard University Hospital Team
Children’s National
Medical Center Team
Georgetown University Hospital Team
George Washington University Medical Center TeamCNMC Children’s Health Center -
Adam’s Morgan Team
Goals of Learning Collaborative to offer Recommended Transition Services
• Transition Policy/welcome process• Adult Privacy and Consent Policy < age 18• Identification and tracking of transitioning
youth/young adults• Transition Readiness Assessment• Up to date portable medical summary and
emergency plan• Transition Planning-improving self
management/advocacy skills
• Transfer communication and shared care
10/1/2012
8
FIRST STEP in The HCT Transition QI Process
• Do you have a transition Policy for your practice?A transition policy is an explicit office policy describing thepractice’s approach to health care transition, including the ageand process at which youth shift to an adult model of care(pediatric) or describing the practice’s privacy and consent policy(adult).
• If yes, do you post it for young adults to see and give it to all new patients in your practice?
Internal Medicine Clinic Privacy and Consent Policy
The Medical Faculty Associates welcomes all youth and young adults including those with chronic pediatric conditions and complex health care needs. We provide an adult model of care for all of our patients 18 years and older with modifications as needed depending on the patient’s intellectual ability and guardianship status. In order to make this a smooth transition, we ask that all new young adult patients provide a portable medical summary or copies of their medical records and in the case of patients with complex chronic conditions, a current care plan. We will also make every effort to coordinate the transfer of care with our new patient’s prior medical home including direct communication with the pediatric medical home team, and assistance with the transfer of specialty care to adult specialists as needed. (cont’d on next)
Internal Medicine Clinic Privacy and Consent Policy
Our approach to the care of young adults age 18 and older meets Federal (HIPPA) and state privacy and consent requirements making the young adult the sole decision-maker about care and about the sharing of personal health information. This means that we do not discuss any aspect of your care with anyone else unless you specifically ask that we do. We understand that many people involve family and close friends in their health care decisions and would like their physician to share information with those close to them. To allow others to be involved in your healthcare decisions requires legal authority through the signed consent of the young adult which we have in clinic. For those that cannot provide consent, we would need a legally valid custodial care or power of attorney documentation, or an adjudicated guardianship arrangement.
Facilitating Seamless Transitions in Care• Policy: Our practice is committed to facilitating seamless transitions across health care facilities and between practices – including transitions of adolescents into adult care practice settings.• Purpose: Poorly managed transitions in care are an important source of medical errors, quality deficiencies, and overuse of medical resources. In addition, youth – especially with chronic needs or rare conditions – often experience inadequate support (social/clinical) through transitions. This policy articulates key elements of a practice-wide approach to providing excellent transitions in care for patients, families and caregivers.• Procedures:
A. For Transitions in Care from Hospitals, Emergency Departments, and other Health Care Facilities to Home…B. For Transitions in Care to/from Hospitals, Emergency Departments, and other Health Care Facilities to/from
Home/Ambulatory Care Office…C. To Support Young Adults’ Transition into Our Practice…The practice:• Adheres to national guidelines pertaining to the transition of adolescence to adulthood;• Uses a standardized check list to ensure that all relevant information is available for the accepting primary care
clinician before the first visit for a young adult with complex or rare conditions;• Follows a Privacy and Consent policy that protects the privacy of patients 18 years old or older and is shared
with all patients/families/caregivers.D. To Ensure the Practice Model is Effective, Efficient and Continually Improves the Transition Processes
Described in Sections A , B & C…The practice routinely assesses:• The timeliness of communications with patients/families/caregivers post-transition;• The timeliness of signatures for home health orders;• Patient/family/caregiver experiences with transitions in care.
Transition Policy• Challenges
– Getting practice/team consensus, especially regarding age limits– Posting and having policy distributed systematically– Difficulties when consent, privacy, and guardianship issues have not been
discussed prior to age 18. Many parents unaware of HIPAA requirements and want to be present during visit.
– Assessing patient’s decision-making ability
• Benefits– Patient Satisfaction-Youth/young adults/families who reviewed the pilot policy
said they were grateful for the information. Many wished they’d had it when their older children were transitioning
– Provider Satisfaction-practice consistency– Clarifies roles of youth/young adults and parents in decision-making– Creates a safe and comfortable environment for those 18 and over to discuss
private concerns regarding their health– Improved adherence and outcomes
Types of Decision Making Support• Informal Supports – Family, friends, and “circle of support” • Money Management – Joint or trust accounts, direct deposit,
direct payment, Social Security representative payee, financial power of attorney, conservator
• Health Care - Health-Care Decisions Act, Durable Power of Attorney for Health Care
• Temporary/Limited / full Guardianship-The specific type of guardianship is defined in the applicable laws for each state/jurisdiction.
• References:– Guardianship webinar available at
http://www.gottransition.org/about-us-news/broadcasts – dcqualitytrust.org: Quality Trust for Individuals with Disabilities
10/1/2012
9
Health & Wellness-The Basics:Yes I do this
I wantto do this
I need To learn
Someone else will have to do this - Who?/NA
1. I understand my health care needs and my chronic illness/disability 2. I can explain my illness, medications and health care needs to others3. I have a list/ can explain my medications and their side effects to others4. I carry my health insurance card everyday
5. I know and pay attention to my baseline health and wellness
6. I track and schedule my own medical appointments
7. I know when to call my provider for prescription refills 8. I know how to call the pharmacy for my refills
9. Before an appointment I prepare written questions to ask or list any concerns I have10. I know what to do when my condition
changes such as when to call my doctor
11. I know what to do in an emergency and have ICE information in my cell phone
Transition Readiness Assessment- For Youth/Young Adults
Transition Readiness Assessment: Benefits
• Solicits greater involvement of patients/families in understanding their ability to manage their own health and health care
• Evaluate youth and young adults’ current healthcare knowledge base and skills and identify areas that need further education
• Ultimately, improves the management of chronic condition and the independence of youth/young adults in their own care
Transition Readiness Assessment: Challenges
• Addressing range of patient education levels into youth and parent assessment that can be used by entire practice
• Identifying practice process for how all youth/young adults and parents receive and fill out assessment
• How to incorporate readiness assessment into transition plan and into visit discussions/follow-up
• How to incorporate readiness assessment into EMR so it can be updated
• Have available updated readiness assessment for transfer packet for adult provider
• Time constraints
Portable Medical Summary • Components of portable medical summary
Basic patient personal and contact information Build Health Family Tree https://familyhistory.hhs.gov/ Medical providers, emergency contacts Diagnosis Pertinent history Current medications, equipment needs Allergies Immunizations Special notes — guardianship status, communication preferences Prevention Actions– General: nutrition, physical activity guidelines, routine screenings, tests
according to age– Specific actions/screenings required due to the family health tree eg heart
disease• Portable and electronic and share with young adult/family (before age 18) &
providers• Developed with institution’s HIT team to generate from EMR
Portable Medical Summary: Benefits
• Improves understanding and self-care management
• Prevents duplication of tests/procedures
• Youth/young adults/parents don’t have to repeatinformation to multiple providers
• Improves patient safety
• Ensures adult providers have accurate information
The Checklist Manifesto: How to get things right
• Atul Gawande distinguishes between errors of:– Ignorance (mistakes we make because we don’t know
enough), and – Ineptitude (mistakes we made because we don’t make
proper use of what we know).
• Failure in the modern world, is really about the second • Solution: Experts need checklists–literally–written guides
that walk them through the key steps in any complex process-pre and post checklists are essential.
10/1/2012
10
• <Patient Name> <Date of Birth>• Adult primary care team receives transfer request from pediatric primary
care practice• Adult primary care team provides “new young adult patient” information
to pediatric primary care team and/or directly to youth (and family as appropriate)
• Pediatric primary care team confirms transfer with adult primary care team
• Pediatric primary care team provides basic information regardingpatient (name, DOB, diagnoses, insurance, guardianship status)
• For youth with special health care needs, personal communication between pediatric and adult primary care providers
• Date of transfer of care determined with mutual agreement• Transfer of care package received by adult primary care team via preferred
or best available means (mail, fax, email, electronic records transfer)
Transfer of Care Package for Adult Providers
Transfer of Care Package for Adult Providers
• Transfer of care package incorporated into adult primary care record includes the following:– Current portable medical summary– Most recent readiness assessment– Final transition plan including– Name and contact information for pediatric primary care provider– Current care plan of pending upcoming action needing to be
completed– Condition-specific “fact sheet”– Effective date for transfer
Evaluation: Medical Home Health Care Transition Index
• Indicator #1: Office health care transition (privacy and consent) policy
• Indicator #2: Staff and provider HCT knowledge and skills and coordination of care
• Indicator #3: Identification of transitioning youth/young adults (registries)
• Indicator #4: Transition preparation (readiness assessments)
• Indicator #5: Transition planning (transition plans)
• Indicator #6: Transfer of care or transition to adult model of careAssessments for pediatric and adult practicesEach HCT team self assess at baseline and 9 months4 levels for each indictor and 2 options (partial or complete) within each
indicator
Adult Transition Index: #1 Office health care transitionpolicy: each level is rated Partial or Complete
Indicator Level 1 (Basic) Level 2 (Responsive) Level 3 (Proactive) Level 4 (Comprehensive)
1: Office health care transition privacy and consent policy
Some providers in the practice will accept new patients who are young adults. Office staff is informally aware of receiving new young adult patients 18 years or older. Discussion among the practice staff only occurs if problems arise.
There is a uniform, clearly written practice-wide privacy and consent policy for receiving new patients that discusses the young adult’s right for privacy and consent. This policy is agreed upon by all providers and shared with staff. The care of young adults transferring care from pediatric practices adheres to this policy.
In addition to level 2, the practice has displayed this practice-wide privacy and consent policy (posters, brochures, website, etc.) to explain practice policy for patients by discussing their right for privacy and consent for medical care. These policies are also handed in writing to new patients>age 18 at the time of their first visit.
In addition to Level 3, the written health care transition privacy and consent policy addresses guardianship information and who should/should not be given access to patient information. By age 18, guardianship, decision-making, and information access rights are determined and clearly identified in the medical record. Practice services include transition encounters,carecoordination, & monitoring of steps/progress.
PartialComplete
PartialComplete
Partical Complete PartialComplete
Health Care Transition Index ResultsDC Transition Project-Adult Practices
Baseline February 2011
Average scores of two practices: one family medicine, one internal medicine
Core elements of health care transition
[Basic]
[Responsive]
[Proactive]
[Comprehensive]
DC LC Pediatric and Adult Practices HCT Index Data
Average total score for each element
10/1/2012
11
Additional Transition Activities• LC spread within each institution• DC transition website –dctransition.org• Collaboration with HSCSN (DC Medicaid insurance)on CME
and enduring CME• Collaboration with AJE on parent and youth transition training• Transition payment pilot with HSCSN• Transition and EPSDT with DHCF and new work gorup• Additional training to community health centers, school
nurses, etc.
Final Thoughts
Choose and Do…complete at least two health care transition improvements in the next month
• Read and share with staff the new AAP clinical report on HCT• Remove, copy, and post the algorithm• Discuss health care transition at office staff meeting• Identify responsible person/team for improving HCT in the office• Draft and adopt a Health Care Privacy and Consent Transition policy, share with
staff, make visible to and discuss with young adults and families• Create welcome packet for youth/young adults transferring to your practice• Reach out and collaborate with a pediatric practice to ensure youth/young adults
are transferred with appropriate information and communication strategies to make you and your staff comfortable in taking on the care of YSHCN and plan to co manage the youth/young adult for a period of time.
• Adopt a Health Care Transition checklist and assist young adults to acquire self management and advocacy skills
Learning Objectives
• Define health care transition and the key role internists play in the process
• List the elements of the AAP/ACP/AAFP clinical report on practice-based implementation of transition planning for all youth/young adults with particular focus on those youth over age 18
• Discuss DC Learning Collaborative process from the internal medicine perspective and report the outcome for internal medicine practices
• Identify quality improvement opportunities for an adult focused practice around the transition of youth/young adults to adult medical care
Thank [email protected]