Supporting the Transition from

Pediatric to Adult Health Care

• 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 – noticed pediatric patients “falling off records” or ending up in ER for episodes which could have been prevented

• 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

HCT Index – Provider Survey

Workflow OverviewFor any office visit over age 12 (12-19 yo) that is not acute in nature: 1. New Document

2. Select Encounter Type (2 with new form)

3. Check “Transition of Care, Peds to Adult” checkbox

4. Click Adolescent Transition of Care button (right)

5. Have age-appropriate conversation regarding transitioning using the form as a guideline

6. Fill out Y/N questions in the form that correspond with patient’s age range

7. Enter comments as clinically indicated

8. Continue with visit as usual and sign note

9. Review information in the patient’s medical record

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

For children ages 12-16 (no

checkbox)

Adolescent Transition of Care Form

• Added to two office visit types:

– PEDS Chronic

– PEDS Well-Child (+1 year) – Physicals

– Any others needed?

• 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

Form Questions (Domain 1)• Increasing Adolescent Responsibility for Healthcare

Management

• Age 12-13 YearsMet privately with the adolescent for part of the office visit.

Adolescent demonstrates understanding of his/her conditions and how to take any prescribed medications.

Adolescent asks questions during each office visit and participates in the care plan.

• Age 14-16 (continues on 17-19) Adolescent is competent in independently making

appointments, filling prescriptions, following up on referrals, and seeking emergency services, as needed.

Adolescent's parents were provided with the opportunity to discuss their feelings about loss of control, concerns about the future, and increasing the adolescent's independence.

Discussed using technology to access health records and communicate with the adolescent's care team.

Form Questions (Domain 2)

• Readiness Assessment for Transfer to Adult Care

• Age 12-13 Years

Initiated discussion about transfer to an adult healthcare provider. Provided copy of transition policy and letter.

• Age 14-16 Years

Discussed choices for adult care and assisted in identifying possible care providers.

• Age 17-19 Years

Discussed plan for health insurance coverage in the future.

Encouraged to meet and interview adult providers.

Initiated communication with the adult provider that the family and adolescent has selected.

Form Questions (Domain 3)

• Implementation of Transfer to Adult

Care

• Age 17-19 Years

Transferred health records.

Discussed nuances of care with the adult

provider.

Followed up after the transfer.

Patient Medical Record

Discussion• Does this workflow seem manageable for you to

complete while rooming the patient and doing the initial intake?

• What issues do your foresee in implementing this form in practice?

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

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

• What educational handouts might you need to supplement the discussion?

QUESTION

S?

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.