Original article
Pediatric to Adult Transition: A Quality Improvement Model for Primary Care

https://doi.org/10.1016/j.jadohealth.2014.08.006Get rights and content

Abstract

Purpose

To examine the relationship between quality improvement activities with pediatric and adult primary care practices and improvements in transition from pediatric to adult care.

Methods

This was a time-series comparative study of changes in pediatric and adult practices involving five large pediatric and adult academic health centers in the District of Columbia. Using the Health Care Transition Index (pediatric and adult versions), we examined improvements in specific indicators of transition performance, including development of an office transition policy, provider knowledge and skills related to transition, identification of transitioning youth, transition preparation of youth, transition planning, and transfer of care.

Results

Improvements took place in all six transition quality indicators in the pediatric and adult practices that participated in a 2-year learning collaborative to implement the “Six Core Elements of Health Care Transition,” a quality improvement intervention modeled after the American Academy of Pediatrics/American Academy of Family Physicians/American College of Physicians Clinical Report on Transition. All sites established a practice-wide policy on transition and created an organized clinical process for tracking transition preparation. The pediatric sites conducted transition readiness assessments with 88% of eligible youth and prepared transition plans for 29% of this group. The adult sites conducted transition readiness assessments with 73% of eligible young adults and developed plans for 33%. A total of 50 were transferred in a systematic way to adult primary care practices.

Conclusions

Quality improvement using the Six Core Elements of Health Care Transition resulted in the development of a systematic clinical transition process in pediatric and adult academic primary care practices.

Section snippets

Methods

This study involved five large academic primary care practices in the District of Columbia (Washington, DC) that participated in a transition LC between 2011 and 2012. Two were adolescent clinics (with 11,000 visits/year and 1,830 visits/year); one was a pediatric clinic (with 15,000 visits/year); one was a family medicine resident clinic (with 10,000 visits/year); and one was an internal medicine clinic (with 35,000 visits/year). Each practice formed a team consisting of a lead physician, a

Office policy on transition

At the outset of the project, all participating sites were at the basic level (AS = 1.2) with respect to an office policy on transition. None of the pediatric practices had a written transition policy, and adult practices had no privacy or consent policy beyond the Health Insurance Portability and Accountability Act (HIPAA) policy routinely given to patients. Between Times 1 and 2, practices made substantial changes (AS = 4.8). Written policies were developed and tested by each transition team,

Discussion

Substantial improvements were made in transition clinical processes in both pediatric and adult practices using the Six Core Elements of Health Care Transition. All pediatric and adult sites established formal practice-wide policies on transition and more clearly informed youth, parents, and young adults about privacy and consent as a basic tenet of adult-centered care. All sites created a systematic method for tracking transitioning youth with chronic conditions, and the vast majority

Acknowledgments

M.M. conceptualized and interpreted the quality improvement results, drafted the background and results for the initial article, and approved the final article submitted. P.W., W.C.C., and J.W.M. made substantial contributions to the design and measurement of the quality improvement model, acquisition and interpretation of results, drafting the article, and gave approval of the final article as submitted. A.B., B.D., K.H., N.Q., and L.T. made significant contributions to the analysis and

References (15)

There are more references available in the full text version of this article.

Cited by (108)

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

    2022, Journal of Pediatric Nursing
    Citation Excerpt :

    Changes the team thought would make big differences did not always occur when tested, such as targeted posters for staff to distribute brochures and tools and posters reminding patients to ask about HCT. As found in other HCT QI projects, support and involvement by the clerical, nursing, and medical administrators was essential for success of the project (McManus et al., 2015). Reviews of the HCT literature have been critical of manuscripts about HCT interventions for not providing enough pragmatic detail for others to incorporate the interventions into practice.

View all citing articles on Scopus

Conflicts of Interest: The authors have indicated that they have no financial relationships relevant to this article or conflicts of interest to disclose.

View full text