Ryan J Coller1, Sarah Ahrens2, Mary L Ehlenbach3, Kristin A Shadman3, Mala Mathur3, Kristin Caldera4, Paul J Chung5,6,7,8, Andrew LaRocque2, Heather Peto3,2, Kole Binger3, Windy Smith9, Ann Sheehy2. 1. Departments of Pediatrics, rcoller@pediatrics.wisc.edu. 2. Medicine, and. 3. Departments of Pediatrics. 4. Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin. 5. Department of Pediatrics, David Geffen School of Medicine and. 6. RAND Health Care, RAND Corporation, Santa Monica, California. 7. Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California. 8. Children's Discovery and Innovation Institute, Mattel Children's Hospital, Los Angeles, California; and. 9. American Family Children's Hospital, Madison, Wisconsin.
Abstract
OBJECTIVES: Adults with chronic conditions originating in childhood experience ongoing hospitalizations; however, efforts to guide youth-adult transitions rarely address transitioning to adult-oriented inpatient care. Our objectives were to identify perceptions of clinical leaders on important and feasible inpatient transition activities and outcomes, including when, how, and for whom inpatient transition processes are needed. METHODS: Clinical leaders at US children's hospitals were surveyed between January and July 2016. Questionnaires were used to assess 21 inpatient transition activities and 13 outcomes. Perceptions about feasible and important outcome measures and appropriate patients and settings for activities were summarized. Each transition activity was categorized into one of the Six Core Elements (policy, tracking, readiness, planning, transfer, or completion). Associations between perceived transition activity importance or feasibility, hospital characteristics, and transition activity performance were evaluated. RESULTS: In total, 96 of 195 (49.2%) children's hospital leaders responded. The most important and feasible activities were identifying patients needing or overdue for transition, discussing transition timing with youth and/or families, and informing youth and/or families that future stays would be at an adult facility. Feasibility, but not importance, ratings were associated with current performance of transition activities. Inpatient transition activities were perceived to be important for children with medical and/or social complexity or high hospital use. Emergency department visits and patient experience during transition were top outcome measurement priorities. CONCLUSIONS: Children's hospital clinical leaders rated inpatient youth-adult transition activities and outcome measures as important and feasible; however, feasibility may ultimately drive implementation. This work should be used to inform initial research and quality improvement priorities, although additional stakeholder perspectives are needed.
OBJECTIVES: Adults with chronic conditions originating in childhood experience ongoing hospitalizations; however, efforts to guide youth-adult transitions rarely address transitioning to adult-oriented inpatient care. Our objectives were to identify perceptions of clinical leaders on important and feasible inpatient transition activities and outcomes, including when, how, and for whom inpatient transition processes are needed. METHODS: Clinical leaders at US children's hospitals were surveyed between January and July 2016. Questionnaires were used to assess 21 inpatient transition activities and 13 outcomes. Perceptions about feasible and important outcome measures and appropriate patients and settings for activities were summarized. Each transition activity was categorized into one of the Six Core Elements (policy, tracking, readiness, planning, transfer, or completion). Associations between perceived transition activity importance or feasibility, hospital characteristics, and transition activity performance were evaluated. RESULTS: In total, 96 of 195 (49.2%) children's hospital leaders responded. The most important and feasible activities were identifying patients needing or overdue for transition, discussing transition timing with youth and/or families, and informing youth and/or families that future stays would be at an adult facility. Feasibility, but not importance, ratings were associated with current performance of transition activities. Inpatient transition activities were perceived to be important for children with medical and/or social complexity or high hospital use. Emergency department visits and patient experience during transition were top outcome measurement priorities. CONCLUSIONS:Children's hospital clinical leaders rated inpatient youth-adult transition activities and outcome measures as important and feasible; however, feasibility may ultimately drive implementation. This work should be used to inform initial research and quality improvement priorities, although additional stakeholder perspectives are needed.
Authors: Denise M Goodman; Matthew Hall; Amanda Levin; R Scott Watson; Roberta G Williams; Samir S Shah; Anthony D Slonim Journal: Pediatrics Date: 2011-06-27 Impact factor: 7.124
Authors: Courtney L Shepard; Ella J Doerge; Adam B Eickmeyer; Kate H Kraft; Julian Wan; John T Stoffel Journal: J Urol Date: 2017-11-04 Impact factor: 7.450
Authors: David L Wood; Gregory S Sawicki; M David Miller; Carmen Smotherman; Katryne Lukens-Bull; William C Livingood; Maria Ferris; Dale F Kraemer Journal: Acad Pediatr Date: 2014 Jul-Aug Impact factor: 3.107
Authors: Yana Vaks; Rachel Bensen; Dana Steidtmann; Thomas D Wang; Terry S Platchek; Donna M Zulman; Elizabeth Malcolm; Arnold Milstein Journal: Healthc (Amst) Date: 2015-10-21