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Advancing pediatric primary care practice: Preparing youth for transition from pediatric to adult medical care, a quality improvement initiative

      Highlights

      • .It’s possible to integrate a HCT workflow starting early, with evidence informed national guidelines tailored to site needs.
      • Surveys of stakeholders on barriers fostered participant engagement and increased adoption of workflow.
      • Using a variety of prompts and incorporating all team members in the QI process.
      • increased uptake of transition workflow.

      Abstract

      Background

      Despite well-known guidelines to prepare adolescents to transition to adult care, research has shown that this is done less than 25% of time in pediatric practice. This quality improvement (QI) project aimed to improve the transition readiness process for all adolescents aged 14–18 at health care maintenance visits.

      Methods

      A multidisciplinary team conducted a quality improvement initiative in a large, urban pediatric academic teaching practice serving a low-income, multi-ethnic population. The team developed transition interventions through successive Plan-Do-Study-Act cycles. They included a formal transition readiness assessment tool, provider-delivered education related to transition readiness, and delivery of a transition brochure for all adolescents. The team used run charts to follow the rate of formal transitions discussions documented in the electronic medical record.

      Results

      Over the course of 36 months the outcome measure of provider documented transition readiness discussions increased from 19 to 64% of the time. Over the same course of time, the process measures of transition brochure distribution and completion of the readiness assessment tool increased from 0 to 94% and 0 to 84% respectively.

      Conclusions

      QI methodology and multidisciplinary coordinating to streamline workflow, distribution of transition information, readiness assessment and provider discussion and documentation can be successfully incorporated into a busy primary care setting. By formalizing and standardizing the transition readiness process, pediatric providers can improve young adults' readiness to transition to adult medical care.

      Keywords

      Abbreviations:

      HCT (Health Care Transition), PCC (Primary Care Clinician), LCSW (Licenced Clinical Social Worker), PSR (Patient Service Representative), PDSA (Plan Do Study Act)
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