Lisa Lestishock1, Sandra Nova2, Jennifer Disabato3. 1. Ravenswood Family Health Center, East Palo Alto, California; Division of Adolescent Medicine, Stanford Children's Health, Menlo Park, California. Electronic address: llestishock@stanfordchildrens.org. 2. Ravenswood Family Health Center, East Palo Alto, California. 3. College of Nursing & School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Abstract
PURPOSE: Health care transition (HCT) is the complex process of changing from pediatric to adult-centered care. Comprehensive HCT processes have been associated with improved outcomes in all elements of the Triple Aim. Nationally accepted best practices emphasize Six Core Elements of HCT, including the use of transition readiness assessment tools completed during clinic visits. Specifically, Got Transition's tools include two 0-10 point self-report scales on the validated domains of importance of changing to an adult provider and managing their healthcare, and confidence in their ability to transition. The aim of this quality improvement project (QIP) was to improve the engagement of adolescents and young adults (AYAs), aged 14-20, in the process of transitioning from pediatric to adult care. The sub-aim focused specifically on parent/caregiver engagement in transition, using the same scales in a tool for parents/caregivers. An urban federally qualified health center initiated this QIP. METHODS: This QIP utilized the Institute for Healthcare Improvement Model for Improvement and plan-do-study-act cycles. RESULTS: Eighty-five AYAs and 40 parents/caregivers completed readiness assessments twice. Scores improved overall, reaching statistical significance with a small change in AYA mean scores for importance (.94) and confidence (.75). Provision of a transition policy and completion of readiness assessments by AYAs and parents/caregivers met the 70% goal. Patient portal enrollments increased from 4.2% to 12.5%, although did not meet the 30% goal. CONCLUSIONS: Engagement of AYAs and parents/caregivers was improved as a result of this QIP. Successful routine implementation of transition process measures demonstrated improved clinic-wide communication.
PURPOSE: Health care transition (HCT) is the complex process of changing from pediatric to adult-centered care. Comprehensive HCT processes have been associated with improved outcomes in all elements of the Triple Aim. Nationally accepted best practices emphasize Six Core Elements of HCT, including the use of transition readiness assessment tools completed during clinic visits. Specifically, Got Transition's tools include two 0-10 point self-report scales on the validated domains of importance of changing to an adult provider and managing their healthcare, and confidence in their ability to transition. The aim of this quality improvement project (QIP) was to improve the engagement of adolescents and young adults (AYAs), aged 14-20, in the process of transitioning from pediatric to adult care. The sub-aim focused specifically on parent/caregiver engagement in transition, using the same scales in a tool for parents/caregivers. An urban federally qualified health center initiated this QIP. METHODS: This QIP utilized the Institute for Healthcare Improvement Model for Improvement and plan-do-study-act cycles. RESULTS: Eighty-five AYAs and 40 parents/caregivers completed readiness assessments twice. Scores improved overall, reaching statistical significance with a small change in AYA mean scores for importance (.94) and confidence (.75). Provision of a transition policy and completion of readiness assessments by AYAs and parents/caregivers met the 70% goal. Patient portal enrollments increased from 4.2% to 12.5%, although did not meet the 30% goal. CONCLUSIONS: Engagement of AYAs and parents/caregivers was improved as a result of this QIP. Successful routine implementation of transition process measures demonstrated improved clinic-wide communication.
Keywords:
Adolescents and young adults; Engagement; Federally qualified health center; Health care transition; Parents/caregivers; Quality improvement; Six Core Elements of Transition; Social complexity; Transition readiness assessment