Transitioning from pediatric to adult services: A public health approach

Due to advances in neonatal and pediatric care, patients with chronic illnesses and disabilities are surviving well into adult life and are faced with needing to navigate the challenging transition to adult care. As with all medical transitions, there is valid concern that patient morbidity and mortality are adversely affected during this time. We carried out a pilot Primary Care Transition Program, a randomized controlled trial that evaluated whether participation in three different transition interventions increased transition readiness, successful transition to an adult care provider and patient, caregiver and provider satisfaction and systematically evaluated and implemented transition plans for CHOP patients and families as they transitioned from pediatric to adult care. Metrics used to measure outcomes include: improvement in transition related skills, including self-management and self-efficacy (measured by administering the validated Transition Readiness Assessment Questionnaire (TRAQ)), patient and family satisfaction, provider satisfaction, and utilization outcomes. Transition readiness was assessed for all study participants, as were able, or from their caregivers, at baseline and at 6 months post-baseline, using the TRAQ.  Successful transition is defined as having attended at least one appointment with an adult PCP within 10 months of the baseline visit.  Satisfaction will be measured using quantitative and qualitative surveys and will be distributed to participants, their caregivers, and the pediatric and adult PCPs involved. At this point the RCT is ongoing. 6-month and 10-month post-intervention surveys are being collected. We have 33 young adults and 10 caregivers enrolled in the study. Analysis will be complete by May 2014.