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Moreno-Galdó A, Regné-Alegret MC, Aceituno-López MA, Camprodón-Gómez M, Martí-Beltran S, Lara-Fernández R, Del-Toro-Riera M. Implementation of programmes for the transition of adolescents to adult care. An Pediatr (Barc) 2023; 99:422-430. [PMID: 38016858 DOI: 10.1016/j.anpede.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/01/2023] [Indexed: 11/30/2023] Open
Abstract
Up to 15-20% of adolescents have a chronic health problem. Adolescence is a period of particular risk for the development or progression of chronic diseases for both individuals with more prevalent conditions and those affected by rare diseases. The transition from paediatric to adult care begins with preparing and training the paediatric patient, accustomed to supervised care, to assume responsibility for their self-care in an adult care setting. The transition takes place when the young person is transferred to adult care and discharged from paediatric care services. It is only complete when the youth is integrated and functioning competently within the adult care system. Adult care providers play a crucial role in welcoming and integrating young adults. A care transition programme can involve transitions of varying complexity, ranging from those required for common and known diseases such as asthma, whose management is more straightforward, to rare complex disorders requiring highly specialized personnel. The transition requires teamwork with the participation of numerous professionals: paediatricians and adult care physicians, nurses, clinical psychologists, health social workers, the pharmacy team and administrative staff. It is essential to involve adolescents in decision-making and for parents to let them take over gradually. A well-structured transition programme can improve health outcomes, patient experience, the use of health care resources and health care costs.
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Affiliation(s)
- Antonio Moreno-Galdó
- Servicio de Pediatría, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Maria Creu Regné-Alegret
- Unidad de Apoyo a la Transición. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Grupo de Investigación Multidisciplinar de Enfermería, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Hospital, Barcelona, Spain
| | - María Angeles Aceituno-López
- Grupo de Investigación Multidisciplinar de Enfermería, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Hospital, Barcelona, Spain; Dirección de Enfermería. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Camprodón-Gómez
- Servicio de Medicina Interna. Unidad de Metabolopatías Hereditarias. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergi Martí-Beltran
- Servicio de Neumología. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Roser Lara-Fernández
- Dirección de Enfermería. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mireia Del-Toro-Riera
- CIBER de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Sección de Neurología Pediátrica. Unidad de Metabolopatías Hereditarias. Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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Hickam T, Maddux MH, Modrcin A, White P. Outcomes of a Structured Ambulatory Care Health Care Transition Approach in a Large Children's Hospital. J Adolesc Health 2023; 73:917-923. [PMID: 37530685 DOI: 10.1016/j.jadohealth.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Without a structured health-care transition (HCT) process, youths with chronic conditions face increased morbidity, care gaps, and dissatisfaction. This article documents the process and outcomes of implementing a standardized approach in a large children's hospital. METHODS Children's Mercy Kansas City adopted Got Transition's Six Core Elements of Health Care Transition and established a system-wide implementation plan, between 2015 and 2019, involving leadership buy-in, consumer engagement, infrastructure improvements, and quality improvement efforts. Outcomes measured included the number of youths aged 12-21 years receiving transition readiness assessments and participating in goal setting, receiving counseling, and receiving a transfer order, if appropriate. Also, Division-specific process outcome surveys were conducted annually using Got Transition's Current Assessment of HCT Activities. RESULTS A total of 8,099 unique patients received a structured HCT intervention using the Six Core Element approach over the 5-year period. From 2015 to 2019 the average annual growth was: 207% for completion of transition readiness and goals assessments, 243% for charting of HCT discussions, and 105% for transfer orders. In 2015, 3/20 (15%) divisions were implementing this HCT intervention; in 2019, 17/20 (85%) divisions were implementing it, representing a 467% growth. Division participation in measuring HCT implementation also increased by 89% from 9/20 in 2016 to 17/20 in 2019. The average Current Assessment of HCT Activities scores increased by 35% from 14.55/32 to 19.67/32 during that time. DISCUSSION This hospital-wide program demonstrates that a standardized HCT process can be successfully implemented in a diverse group of outpatient pediatric primary and subspecialty care settings.
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Affiliation(s)
- Teresa Hickam
- Department of Social Work, Children's Mercy Kansas City, Kansas City, Missouri
| | - Michele H Maddux
- Division of Gastroenterology, Children's Mercy Kansas City, Kansas City, Missouri; Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Missouri.
| | - Ann Modrcin
- Department of Pediatrics, School of Medicine, University of Missouri Kansas City, Missouri; Division of Rehabilitation Medicine, Children's Mercy Kansas City, Kansas City, Missouri
| | - Patience White
- Got Transition, Washington, D.C.; Department of Medicine and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, D.C
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Peterson RJ, Patel P, Torke A, Ciccarelli MR, Jenkins AM. Adult Inpatient Services in Pediatric Hospitals: A National Mixed Methods Study. Hosp Pediatr 2023; 13:775-783. [PMID: 37575081 DOI: 10.1542/hpeds.2022-007086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Some pediatric institutions have developed adult inpatient services to enable quality care of hospitalized adults. Our objectives were to understand the characteristics of these adult inpatient services in pediatric hospitals, barriers and facilitators to their creation and sustainability, and patient and system needs they addressed. METHODS An explanatory mixed methods study was conducted using a distribution of an electronic survey followed by targeted semi-structured interviews of directors (or designates) of adult inpatient services in US pediatric hospitals. The survey identified institutional demographics, service line characteristics, and patient populations. An interview guide was created to explore survey findings and facilitators and barriers in the creation of adult inpatient services. Interviews were conducted after survey completion. A codebook was created using an inductive thematic approach and iteratively refined. Final themes were condensed, and illustrative quotes selected. RESULTS Ten institutions identified as having an adult inpatient service. Service staffing models varied, but all had dually trained internal medicine and pediatrics physicians. All participants voiced their respective pediatric institutions valued that these services filled a clinical care gap for hospitalized adults adding to whole-person care, patient safety, and health system navigation. CONCLUSIONS Adult inpatient services in pediatric institutions have been present for >15 years. These services address clinical care gaps for adults hospitalized in pediatric institutions and use specialized internal medicine and pediatrics knowledge. Demonstrating return on investment of these services using a traditional fee for service model is a barrier to creation and sustainability.
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Affiliation(s)
- Rachel J Peterson
- Departments of Pediatrics
- Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Palka Patel
- Departments of Pediatrics
- Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alexia Torke
- Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary R Ciccarelli
- Departments of Pediatrics
- Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ashley M Jenkins
- Departments of Medicine
- Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Medforth N, Boyle C. Challenges, Complexity, and Developments in Transition Services for Young People with Disabilities, Mental Health, and Long-Term Conditions: An Integrative Review. Compr Child Adolesc Nurs 2023; 46:180-200. [PMID: 37639678 DOI: 10.1080/24694193.2023.2245473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
Transition to adulthood for young people is complex and multi-faceted, with additional hurdles for young people who have disabilities, long-term, or life-limiting conditions or mental health problems. The challenges in providing effective transition support are not new; researchers, policymakers, commissioners, and service providers have been grappling with the problem for several decades, with varying degrees of success. The aims of this integrative review were firstly to build on previous research to synthesize and evaluate recently published evidence. Secondly to provide an overview of the effectiveness of interventions (in one or a combination of health, social care, and education transitions) designed to support transition to adulthood in these groups of young people. A search of a range of databases retrieved published literature from January 2015 to January 2021 demonstrating global interest in the topic. Fifty-one articles were included following an appraisal of quality and eligibility. Qualitative, quantitative, mixed methods studies, and evidence synthesis were included. Some studies were clinically orientated whilst others examined the impact of the transition process, or utilized participatory approaches which give young service-users and families a voice. Transition between children's and adult health or care services as well as other life-course trajectories, such as life-skills development, education transitions, social inclusion and employability were evaluated. Thematic analysis and synthesis of articles retrieved in this review highlighted themes identified in previous reviews: timing of, and preparation for transition; perceptions and experience of transition; barriers and facilitators; transition outcomes. Additional themes included special considerations; dealing with complexity; advocacy, participation, autonomy, aspirations, and young people's rights; future work, research, and evaluation. Novel perspectives and diverse data sources contributed to holistic understanding of an ongoing priority for international policy, service development, and research: the complexity of providing effective transition support and achieving positive outcomes for young people with long-term and life-limiting health conditions, disabilities, and mental health difficulties.
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Liu A, Patel J, Gold JI, Baker NA, Rossi Foulkes R. The Role of Internal Medicine-Pediatric Programs and Transition Champions in Graduate Medical Trainee Health Care Transition Development. J Adolesc Health 2023:S1054-139X(23)00147-7. [PMID: 37140521 PMCID: PMC10363201 DOI: 10.1016/j.jadohealth.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/31/2023] [Accepted: 02/26/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Transition to adult health care for adolescents and young adults (AYAs), especially those with chronic conditions, is a critical time. Medical trainees lack competency in providing transition care, but little is known about the factors contributing to the development of health care transition (HCT) knowledge, attitudes, and practice. This study examines how Internal Medicine-Pediatrics (Med-Peds) programs and institutional HCT champions influence trainee HCT knowledge, attitudes, and practices. STUDY DESIGN A 78-item electronic survey regarding the knowledge, attitudes, and practices of caring for AYA patients was sent to trainees from 11 graduate medical institutions. RESULTS A total of 149 responses were analyzed, including 83 from institutions with Med-Peds programs and 63 from institutions without Med-Peds programs. Trainees with an institutional Med-Peds Program were more likely to identify an institutional HCT champion (odds ratio, 10.67; 95% confidence interval, 2.40-47.44; p = .002). The mean HCT knowledge scores and use of a routine, standardized HCT tools were higher in trainees with an institutional HCT champion. Trainees without an institutional Med-Peds program experienced more barriers to HCT education. Trainees with institutional HCT champions or Med-Peds programs reported greater comfort in providing transition education and using validated, standardized transition tools. DISCUSSION The presence of a Med-Peds residency program was associated with a greater likelihood of a visible institutional HCT champion. Both factors were associated with increased HCT knowledge, positive attitudes, and HCT practices. Both clinical champions and adoption of Med-Peds program curricula will enhance HCT training within graduate medical education.
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Affiliation(s)
- Allison Liu
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
| | - Jay Patel
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Jessica I Gold
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nabil Abou Baker
- The Department of Medicine, University of Chicago, Chicago Illinois
| | - Rita Rossi Foulkes
- Departments of Medicine and Pediatrics, Cedars-Sinai Health Systems, Los Angeles, California
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Del Rosario E, Bodden A, Sala DA, Goodman A, Lam C, Karamitopoulos M. Transition program: Initial implementation with adults with neuromuscular conditions. J Pediatr Nurs 2022; 67:52-56. [PMID: 35939953 DOI: 10.1016/j.pedn.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To identify current medical and psychosocial needs and to examine the effectiveness of healthcare transition program for adult-aged patients with neuromuscular conditions transitioning from pediatric to adult services. DESIGN AND METHODS At Neuromuscular Transition Clinic visit, 46 patients were evaluated and referred to adult-based providers, if did not currently have one, from an acquired list of interested clinicians. At mean follow-up of 22 months, 42 were interviewed by phone regarding referrals for Core Services (primary care, physiatry, dental care and gynecology), Medical Specialties and Rehabilitation Services. Mean age was 30 years with 62% males. Majority (74%) had cerebral palsy. Sixty percent were non-ambulatory. RESULTS As per protocol, all were indicated to need Core Services. Eighty-three percent already had adult primary care provider. Most referrals were given for physiatry (62%), vocational training (100%), and occupational therapy (88%). At follow-up, visits were completed most frequently with adult provider for primary care (100%), occupational therapy (78%), and neurology (75%). Referred provider was seen 100% for physiatry, neurology, physical therapy, occupational therapy and vocational training. Of the total 125 referrals given across all services, 73 (58%) participants had completed a visit with an adult provider. CONCLUSIONS As only about 60% transitioned to adult-based services after referral, healthcare transition remains challenging and requires tailoring of services according to patients' needs, staff and willing-and-available adult-based providers. PRACTICE IMPLICATIONS Transitioning healthcare of patients with neuromuscular conditions from pediatric- to adult-based providers remains challenging. This clinical specialty requires tailoring of services based on patient's needs, and availability of adult-based providers and resources.
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Affiliation(s)
- Eduardo Del Rosario
- Hassenfeld Children's Hospital of New York at NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA.
| | - Adella Bodden
- Hassenfeld Children's Hospital of New York at NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Debra A Sala
- Hassenfeld Children's Hospital of New York at NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Aline Goodman
- Hassenfeld Children's Hospital of New York at NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Connie Lam
- Initiative for Women with Disabilities, NYU Langone Health, New York, NY, USA
| | - Mara Karamitopoulos
- Hassenfeld Children's Hospital of New York at NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY, USA
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Fremion E, Cowley R, Berens J, Staggers KA, Kemere KJ, Kim JL, Acosta E, Peacock C. Improved health care transition for young adults with developmental disabilities referred from designated transition clinics. J Pediatr Nurs 2022; 67:27-33. [PMID: 35882113 DOI: 10.1016/j.pedn.2022.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Young adults with intellectual/developmental disabilities (YAIDD) are a vulnerable population during HCT due to their complex care coordination and adaptive needs, yet factors associated with transition preparedness are not well defined. We aimed to determine factors associated with health care transition (HCT) preparation satisfaction for YAIDD establishing care with an adult medical home. DESIGN AND METHODS 408 YAIDD or their families completed the HCT Feedback Survey 2.0 upon establishing adult care. Logistic regression models were used to determine associations between a composite of six HCT Feedback Survey questions that most correlated with the 2019 National Survey of Children's Health transition questions. RESULTS YADD who had HCT preparation visits with a designated HCT clinic were 9 times more likely to have met all six composite HCT criteria after controlling for the number of technologies required and race/ethnicity (adj OR 9.04, 95% CI: 4.35, 18.76) compared to those referred from the community. Compared to patients who were referred from the community, the odds of feeling very prepared versus somewhat or not prepared were 3.7 times higher (adj OR 3.73, 95% CI: 1.90, 7.32) among patients referred from a designated HCT program. CONCLUSIONS YAIDD who participated in a structured HCT program prior to transfer to adult care experienced higher transition preparation satisfaction. PRACTICAL IMPLICATIONS A structured HCT clinic model to prepare adolescents with DD for transition to adult care may improve HCT preparation satisfaction for this population.
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Affiliation(s)
- Ellen Fremion
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA.
| | - Rachel Cowley
- Baylor College of Medicine, Student Affairs, One Baylor Plaza, Houston, TX 77030, USA
| | - John Berens
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Kristen A Staggers
- Baylor College of Medicine, Dan L Duncan Institute for Clinical and Translational Research, One Baylor Plaza, Houston, TX 77030, USA
| | - K Jordan Kemere
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Judy Lu Kim
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Elisha Acosta
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
| | - Cynthia Peacock
- Baylor College of Medicine, Department of Internal Medicine, Section Transition Medicine, 7200 Cambridge St Suite 8a, Houston, TX 77030, USA
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Doucet S, Splane J, Luke A, Asher KE, Breneol S, Pidduck J, Grant A, Dionne E, Scott C, Keeping‐Burke L, McIsaac J, Gorter JW, Curran J. Programmes to support paediatric to adult healthcare transitions for youth with complex care needs and their families: A scoping review. Child Care Health Dev 2022; 48:659-692. [PMID: 35170064 PMCID: PMC9543843 DOI: 10.1111/cch.12984] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/17/2022] [Accepted: 02/07/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND An increasing number of children have complex care needs (CCN) that impact their health and cause limitations in their lives. More of these youth are transitioning from paediatric to adult healthcare due to complex conditions being increasingly associated with survival into adulthood. Typically, the transition process is plagued by barriers, which can lead to adverse health consequences. There is an increased need for transitional care interventions when moving from paediatric to adult healthcare. To date, literature associated with this process for youth with CCN and their families has not been systematically examined. OBJECTIVES The objective of this scoping review is to map the range of programmes in the literature that support youth with CCN and their families as they transition from paediatric to adult healthcare. METHODS The review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews. A search, last run in April 2021, located published articles in PubMed, CINAHL, ERIC, PsycINFO and Social Work Abstracts databases. RESULTS The search yielded 1523 citations, of which 47 articles met the eligibility criteria. A summary of the article characteristics, programme characteristics and programme barriers and enablers is provided. Overall, articles reported on a variety of programmes that focused on supporting youth with various conditions, beginning in the early or late teenage years. Financial support and lack of training for care providers were the most common transition program barriers, whereas a dedicated transition coordinator, collaborative care, transition tools and interpersonal support were the most common enablers. The most common patient-level outcome reported was satisfaction. DISCUSSION This review consolidates available information about interventions designed to support youth with CCN transitioning from paediatric to adult healthcare. The results will help to inform further research, as well as transition policy and practice advancement.
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Affiliation(s)
- Shelley Doucet
- Centre for Research in Integrated CareUniversity of New BrunswickSaint JohnNew BrunswickCanada
| | - Jennifer Splane
- Centre for Research in Integrated CareUniversity of New BrunswickSaint JohnNew BrunswickCanada,Faculty of HealthDalhousie UniversityHalifaxNova ScotiaCanada
| | - Alison Luke
- Centre for Research in Integrated CareUniversity of New BrunswickSaint JohnNew BrunswickCanada
| | - Kathryn E. Asher
- Centre for Research in Integrated CareUniversity of New BrunswickSaint JohnNew BrunswickCanada
| | - Sydney Breneol
- School of NursingDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Amy Grant
- Nova Scotia Health AuthorityHalifaxNova ScotiaCanada
| | - Emilie Dionne
- St. Mary's Research Centre & Family MedicineMcGill UniversityMontrealQuebecCanada
| | | | - Lisa Keeping‐Burke
- Department of Nursing and Health SciencesUniversity of New BrunswickSaint JohnNew BrunswickCanada
| | - Jessie‐Lee McIsaac
- Faculty of Education and Department of Child and Youth StudyMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Jan Willem Gorter
- Pediatric Rehabilitation MedicineUniversity Medical Centre UtrechtUtrechtThe Netherlands,Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Janet Curran
- School of NursingDalhousie UniversityHalifaxNova ScotiaCanada
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Jenkins AM, Berry JG, Perrin JM, Kuhlthau K, Hall M, Dunbar P, Hoover C, Garrity B, Crossman M, Auger K. What Types of Hospitals Do Adolescents and Young Adults With Complex Chronic Conditions Use? Acad Pediatr 2022; 22:1033-1040. [PMID: 34936941 DOI: 10.1016/j.acap.2021.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/30/2021] [Accepted: 12/15/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Hospitalizations for children with complex chronic conditions (CCC) at pediatric hospitals have risen over time. Little is known about what hospital types, pediatric or adult, adolescents, and young adults (AYA) with CCCs use. We assessed the types of hospitals used by AYAs with CCCs. METHODS We performed a cross-sectional study of 856,120 hospitalizations for AYAs ages 15-to-30 years with ≥1 CCC in the 2017 National Inpatient Sample. We identified AYA with CCC by ICD-10-CM diagnosis codes using the pediatric CCC classification system version 2. Hospital types included pediatric hospitals (n = 70), adult hospitals with pediatric services (n = 277), and adult hospitals without pediatric services (n = 3975). We analyzed age trends by hospital type and CCC count in 1-year intervals and dichotomously (15-20 vs 21-30 years) with the Cochran-Armitage test. RESULTS The largest change in pediatric hospitals used by AYA with CCCs occurred between 15 and 20 years with 39.7% versus 7.7% of discharges respectively (P< 0.001). For older AYA (21 to 30 years), 1.0% of discharges occurred at pediatric hospitals, compared with 65.6% at adult hospitals without pediatric services (P < 0.001). Older AYA at pediatric hospitals had more technology dependence (42.5%) versus younger AYA (27.6%, p < 0.001). CONCLUSIONS Most discharges for AYAs ≥21 years with CCCs were from adult hospitals without pediatric services. Higher prevalence of technology dependence and neuromuscular CCCs, as well as multiple CCCs, for AYA 21-to-30 years discharged from pediatric hospitals may be related to specific care needs only found in pediatric settings and challenges transferring into adult hospital care.
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Affiliation(s)
- Ashley M Jenkins
- Division of Hospital Medicine (AM Jenkins, K Auger), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Internal Medicine (AM Jenkins), University of Cincinnati Medical Center, Cincinnati, OH.
| | - Jay G Berry
- Division of General Pediatrics (JG Berry, P Dunbar, B Garrity), Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - James M Perrin
- Division of General Academic Pediatrics, Department of Pediatrics (JM Perrin, K Kuhlthau), MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Karen Kuhlthau
- Division of General Academic Pediatrics, Department of Pediatrics (JM Perrin, K Kuhlthau), MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass
| | - Matt Hall
- Children's Hospital Association (M Hall), Lenexa, KS
| | - Peter Dunbar
- Division of General Pediatrics (JG Berry, P Dunbar, B Garrity), Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | | | - Brigid Garrity
- Division of General Pediatrics (JG Berry, P Dunbar, B Garrity), Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | | | - Katherine Auger
- Division of Hospital Medicine (AM Jenkins, K Auger), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine (K Auger), Cincinnati, OH; James M. Anderson Center for Health Systems Excellence (K Auger), Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Sandquist M, Davenport T, Monaco J, Lyon ME. The Transition to Adulthood for Youth Living with Rare Diseases. CHILDREN 2022; 9:children9050710. [PMID: 35626888 PMCID: PMC9139297 DOI: 10.3390/children9050710] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 12/03/2022]
Abstract
More children with rare diseases survive into adulthood. The transition period to adult healthcare presents many challenges for pediatric rare diseases. Few adolescents or their families receive any transitional support for the transition to adult healthcare or for their maturing psychosocial needs. Understanding the challenges in the transition process is critical to ensure that interventions designed to improve the transition are holistic and meet the needs of the youth and their families. Few transition programs are in place to meet the needs of those youth with rare diseases who cannot participate in medical decision making or who live independently because of severe disabilities and comorbidities. We searched the literature on preparation and outcomes for youth living with rare diseases in PubMed, CINAHL, and PsychInfo, excluding publications before 2010. The results revealed seven studies specific to rare diseases, special needs, or chronic conditions. Next, we discussed transition with experts in the field, GotTransition.org, and citation chaining, yielding a total of 14 sources. The barriers and challenges to transition were identified. Articles discussing solutions and interventions for transition in medically complex children were categorized care coordination or transition readiness. A large portion of children with rare disease are underserved and experience health disparities in transition.
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Affiliation(s)
- Melanie Sandquist
- Children’s National Hospital, Center for Translational Research, Washington, DC 20010, USA;
- Milken School of Public Health, George Washington University, Washington, DC 20010, USA
| | - TjaMeika Davenport
- Children’s National Hospital, Goldberg Center for Community Pediatric Health, Washington, DC 20010, USA;
| | - Jana Monaco
- Children’s National Hospital, National Patient and Family Advisory Council, Washington, DC 20010, USA;
| | - Maureen E. Lyon
- Children’s National Hospital, Center for Translational Research, Washington, DC 20010, USA;
- School of Medicine and Health Sciences, George Washington University, Washington, DC 20052, USA
- Correspondence:
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Moza R, Fish D, Peterson RJ. Workforce Characteristics of Med-Peds Hospitalists. Cureus 2022; 14:e24799. [PMID: 35676991 PMCID: PMC9169433 DOI: 10.7759/cureus.24799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/07/2022] [Indexed: 11/19/2022] Open
Abstract
Objective This article aims to describe the workplace characteristics of internal medicine and pediatrics (med-peds) hospitalists practicing hospital medicine (as internal medicine hospitalists, pediatric hospitalists, or both) in the United States. Methods The investigators conducted a cross-sectional survey of med-peds hospitalists via distribution through online platforms supported by the Society of Hospital Medicine (SHM), the American Academy of Pediatrics (AAP), and Twitter™. This sample was then reviewed and evaluated for similarities and differences in workplace characteristics. Results One hundred and sixteen respondents completed the survey and provided data on 63 unique institutions employing med-peds hospitalists. Of these institutions, 46% (n=29) employed six or more med-ped hospitalists within their hospital system. Furthermore, 44% (n = 28) of the institutions utilized the med-peds skillset to meet patient care needs in their hospitals. Forty hospitalists from 24 unique institutions saw both adults and children on the same day. Only 5.6% (n=6) of respondents were fellowship-trained. Interestingly, 34.9% of institutions (n=22) were required to provide adult-based care (age >21 years) within the pediatric hospital due to the COVID-19 pandemic. Of note, 35.5% (n=38) of participants from 24 unique institutions stated a high likelihood of hiring additional med-peds hospitalists in the next one to two years. Conclusions Med-peds hospitalists have a unique role within the hospitalist workforce given the variety of practice patterns and clinical needs they can fill within a hospital system. This survey provides the first sampling of workplace characteristics for actively practicing med-peds hospitalists in the United States.
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Sadun RE, Covert LT, Lawson EF. Transitioning to Adulthood with a Rheumatic Disease: A Case-Based Approach for Rheumatology Care Teams. Rheum Dis Clin North Am 2021; 48:141-156. [PMID: 34798943 DOI: 10.1016/j.rdc.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Both pediatric and adult rheumatology care teams play a central role in health care transition, the shift from child- and family-centered to adult-oriented health care. Components of transition preparation include readiness assessment, setting self-management goals, and spending time in clinical visits without a parent present. Pediatric providers and families should work together to create a transfer plan, identifying a new adult rheumatology care provider, providing a medical summary before transfer, and anticipating changes in health insurance. For high-risk transfers, direct communication between providers is recommended. Finally, adult rheumatologists need to build rapport with young adults to support future engagement in care.
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Affiliation(s)
- Rebecca E Sadun
- Department of Medicine, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA; Department of Pediatrics, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA.
| | - Lauren T Covert
- Department of Pediatrics, Division of Rheumatology, Duke University Medical Center, Durham, NC, USA
| | - Erica F Lawson
- Department of Pediatrics, Division of Rheumatology, University of California San Francisco School of Medicine, San Francisco, CA, USA
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Koscielniak NJ, Dharod A, Moses A, Bundy R, Feiereisel KB, Albertini LW, Palakshappa D. Feasibility of computerized clinical decision support for pediatric to adult care transitions for patients with special healthcare needs. JAMIA Open 2021; 4:ooab088. [PMID: 34738078 PMCID: PMC8564708 DOI: 10.1093/jamiaopen/ooab088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/21/2021] [Accepted: 10/07/2021] [Indexed: 11/14/2022] Open
Abstract
The objective of this study was to determine the feasibility of a computerized clinical decision support (cCDS) tool to facilitate referral to adult healthcare services for children with special healthcare needs. A transition-specific cCDS was implemented as part of standard care in a general pediatrics clinic at a tertiary care academic medical center. The cCDS alerts providers to patients 17-26 years old with 1 or more of 15 diagnoses that may be candidates for referral to an internal medicine adult transition clinic (ATC). Provider responses to the cCDS and referral outcomes (e.g. scheduled and completed visits) were retrospectively analyzed using descriptive statistics. One hundred and fifty-two patients were seen during the 20-month observation period. Providers referred 87 patients to the ATC using cCDS and 77% of patients ≥18 years old scheduled a visit in the ATC. Transition-specific cCDS tools are feasible options to facilitate adult care transitions for children with special healthcare needs.
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Affiliation(s)
- Nikolas J Koscielniak
- Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adam Moses
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Richa Bundy
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kirsten B Feiereisel
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Laurie W Albertini
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Consultation Needs for Young Adults with Intellectual and Developmental Disabilities Admitted to an Adult Tertiary Care Hospital: Implications for Inpatient Practice. J Pediatr Nurs 2021; 60:288-292. [PMID: 34392020 DOI: 10.1016/j.pedn.2021.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/31/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Children with intellectual and developmental disabilities (IDD), particularly those with medical complexity, account for a large proportion of pediatric inpatients and are increasingly surviving to adulthood. However, few studies have evaluated the inpatient care of this population after transition to adult hospitals. This paper describes a Med-Peds Hospitalist service providing inpatient consultation for young adults with childhood conditions and offers a window into issues likely to be faced by young adults with IDD as they face increased admissions to adult hospitals. METHODS A single center retrospective chart review was performed of adults with intellectual and developmental disabilities referred to the Med-Peds consult service at a large urban adult academic medical center. FINDINGS The most common medical recommendations provided focused on diagnosis and management of gastrointestinal, neurologic, and respiratory issues. Coordination between pediatric and adult caregivers, disposition planning, communication and family support, and guidance on weight-based dosing were also commonly provided services. DISCUSSION Young adults with IDD face new challenges when admitted to adult hospitals. In this single-center study, several areas were identified where expert consultation could be helpful. The need for structured coordination of care for this vulnerable patient population was highlighted. Knowledgeable consultative services may be an effective intervention to address the unique needs of hospitalized young adults with IDD. APPLICATION TO PRACTICE Hospitals should consider structured inpatient programs, care-paths, or consultation from providers knowledgeable in the care of young adults with intellectual disabilities in order to improve the inpatient care of this population.
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El-Hage L, Ratner L, Sridhar S, Jenkins A. Lessons Learned From the Pediatric Overflow Planning Contingency Response Network: A Transdisciplinary Virtual Collaboration Addressing Health System Fragmentation and Disparity During the COVID-19 Pandemic. J Hosp Med 2021; 16:jhm.3668. [PMID: 34424187 DOI: 10.12788/jhm.3668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/18/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Laura El-Hage
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leah Ratner
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Shela Sridhar
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women's Hospital, Boston Massachusetts
| | - Ashley Jenkins
- Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, New York
- Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, New York
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Schlüer AB. Die Essenz der Pädiatrischen Pflege. Pflege 2020; 33:335-336. [PMID: 33236696 DOI: 10.1024/1012-5302/a000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anna-Barbara Schlüer
- Pflegeentwicklung & Forschungszentrum für das Kind, Universitäts-Kinderspital Zürich
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Abstract
Children with medical complexity have complex health management and care coordination needs. Care models that address these needs rely on interprofessional teams that include NPs. Understanding these care models allows NPs from all disciplines to support the care of this growing patient population in pediatric and adult settings.
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Razon AN, Greenberg A, Trachtenberg S, Stollon N, Wu K, Ford L, El-Hage L, Quinn S, Szalda D. A Multidisciplinary Transition Consult Service: Patient Referral Characteristics. J Pediatr Nurs 2019; 47:136-141. [PMID: 31129412 DOI: 10.1016/j.pedn.2019.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Children's hospitals must provide developmentally appropriate care to increasing numbers of young adults with complex healthcare needs as they transition to adult-oriented care. This article describes the patients, service, and short-term outcomes of an interprofessional healthcare transition (HCT) consult team comprised of nurses, social workers, a community health worker, and physicians. DESIGN AND METHODS The Adult Consult Team's tiered population framework stratifies patients by medical complexity. The team coordinates HCT services for patients with the highest complexity. Patients at least 18 years old are eligible if they have at least two specialists or an intellectual or developmental disability (IDD). Through a comprehensive medical and psychosocial assessment, the team prepares patients/families for adult-oriented healthcare. RESULTS The Adult Consult Team received 197 referrals from July 2017 to June 2018. Patients had at least two specialists (73%), IDD (71%), technology dependence (e.g., gastrostomy tube, 37%) and Medicaid insurance (57%). The team assisted patients seen in its outpatient clinic with navigating mental health services (39%), insurance issues (13%), IDD services (15%), and the guardianship process (37%) and creating comprehensive care plans. CONCLUSIONS The Adult Consult Team transferred 30 patients with medical complexity to adult primary and specialty care, significantly improving pediatric inpatient and outpatient capacity for pediatric-aged patients. A broad range of young adult medical, psychosocial, legal, educational, and vocational needs were addressed. PRACTICE IMPLICATIONS An interprofessional team approach can help large pediatric healthcare systems address the multi-faceted needs of patients who are medically and psychosocially complex as they enter adulthood.
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Affiliation(s)
- Angelico N Razon
- Children's Hospital of Philadelphia, United States of America; Perelman School of Medicine at the University of Pennsylvania, United States of America; Leonard Davis Institute of Economics, University of Pennsylvania, United States of America.
| | - Adam Greenberg
- Children's Hospital of Philadelphia, United States of America
| | | | - Natalie Stollon
- Children's Hospital of Philadelphia, United States of America
| | - Katherine Wu
- Children's Hospital of Philadelphia, United States of America
| | - Lauren Ford
- Children's Hospital of Philadelphia, United States of America
| | - Laura El-Hage
- Children's Hospital of Philadelphia, United States of America; Perelman School of Medicine at the University of Pennsylvania, United States of America
| | - Sheila Quinn
- Children's Hospital of Philadelphia, United States of America; Perelman School of Medicine at the University of Pennsylvania, United States of America
| | - Dava Szalda
- Children's Hospital of Philadelphia, United States of America; Perelman School of Medicine at the University of Pennsylvania, United States of America; Leonard Davis Institute of Economics, University of Pennsylvania, United States of America
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