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Allen CC, Swanson BL, Zhang X, Coller RJ, Olson KR. Quality Improvement Identifies Healthcare Transition Disparities in Adolescents with Congenital Heart Disease and Disabilities. Pediatr Qual Saf 2024; 9:e732. [PMID: 38807581 PMCID: PMC11132416 DOI: 10.1097/pq9.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/28/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction We aim to implement healthcare transition (HCT) education for youth with congenital heart disease (CHD) and assess HCT preparedness for cardiac self-care. Methods An HCT clinic was implemented at an academic pediatric cardiology clinic for CHD youth 17 years of age and older. An educator used transition readiness assessment questionnaires and discussed HCT material. The percentage of eligible youth who received HCT education and the cause for missed occurrences were tracked. Plan-do-study-act cycles began in August 2020 to improve the number of youths reached. Secondary analyses assessed improvement differences among those without cardiac procedures or disabilities. Results HCT education provision improved from a mean of 38% to 73% in the 17-year and older age group by December 2022. Communication failure was the leading cause of missed visits in 2021 (30%), reduced to 0 by 2022 following plan-do-study-act cycles. Other missed HCT visits included clinic add-ons after screening, limited staff availability, and unidentified eligibility. Readiness assessments were similar for youth with and without prior cardiac procedures, for example, confidence in taking charge of their health care (P = 0.47) and moving to adult care (P = 0.22). Adolescents with disabilities were significantly less confident than those without disabilities in taking charge of their heart health care (6.3 versus 7.5, P = 0.04) and moving to adult care (4.9 versus 7.4, P < 0.001). Conclusions Implementation of a CHD HCT clinic improved successful education delivery. Provider engagement and clinic staffing are important for sustainability. HCT knowledge gaps exist for all adolescents, yet those with disabilities had the greatest deficits.
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Affiliation(s)
- Catherine C. Allen
- From the Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Briana L. Swanson
- Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Xiao Zhang
- From the Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Ryan J. Coller
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Krisjon R. Olson
- From the Division of Pediatric Cardiology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
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Allende-Richter S, Benitez AD, Ramirez M, Rivera W, Liu S, Gray KP, Bourgeois F. A Patient Portal Intervention to Promote Adolescent and Young Adult Self-Management Skills. Acad Pediatr 2023; 23:1252-1258. [PMID: 36764579 DOI: 10.1016/j.acap.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Failure to transfer care to adult medicine is associated with gaps in health care access and poor health outcomes among young adults. We examined whether a patient portal educational intervention is acceptable and can improve adolescent and young adult (AYA) self-management skills toward transition readiness to adult care. METHODS We conducted a single site feasibility study using a mixed research method consisting of 1) a patient portal one-on-one educational intervention with pre- and postsurveys adapted from the Transition Readiness Assessment Questionnaire to assess participant self-management skills and portal user activity; 2) portal user experience was assessed through semistructured interviews until thematic saturation was reached. Study participants were 13 to 25 years old and received care at an academic-affiliated community pediatric clinic. Descriptive statistics were used to describe participant characteristics, paired t tests, or Wilcoxon signed-rank tests to assess outcomes of survey response changes pre- versus postintervention. RESULTS Sixty percent of enrolled participants (N = 78) completed the surveys. Following the educational intervention, we observed an increase in participants self-reporting knowing how to access their protected health information P < .0001, (95%, confidence interval [CI], 1-2) and in the proportion of participants self-reporting to strongly agree to know their medication P = .025 (95%, CI 0-1). We also observed an increase in portal user access at 3 weeks; the median number of logins was 2 per participant (range 1-36, P < .0001). The Portal user experience was strongly positive. CONCLUSION Our patient portal educational intervention suggests that AYAs welcome a patient portal to access protected health information and is associated with an increase in the proportion of participants self-reporting to strongly agree with knowing their medication. While these results are encouraging, this is a quasiexperimental study designed on the frame of feasibility. Our study was not adequately powered, limiting our findings' significance. Future interventions would benefit from a larger sample size with a comparison group to ascertain the effect of a patient portal on self-management skills in a diverse AYA population and inform best practices.
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Affiliation(s)
- Sophie Allende-Richter
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Allende-Richter, KP Gray, F Bourgeois) Harvard Medical School, Boston, Mass.
| | - Ashley D Benitez
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Community Health (AD Benitez, M Ramirez), Tufts University, Boston, Mass
| | - Melanie Ramirez
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Community Health (AD Benitez, M Ramirez), Tufts University, Boston, Mass
| | - William Rivera
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass
| | - Shanshan Liu
- Biostatistics and Research Design Core (S Liu, KP Gray), Institutional Centers of Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Kathryn P Gray
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Allende-Richter, KP Gray, F Bourgeois) Harvard Medical School, Boston, Mass; Biostatistics and Research Design Core (S Liu, KP Gray), Institutional Centers of Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Fabienne Bourgeois
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Allende-Richter, KP Gray, F Bourgeois) Harvard Medical School, Boston, Mass
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Davidson LF, St Martin V, Faro EZ. Advancing pediatric primary care practice: Preparing youth for transition from pediatric to adult medical care, a quality improvement initiative. J Pediatr Nurs 2022; 66:171-178. [PMID: 35797807 DOI: 10.1016/j.pedn.2022.06.007] [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: 12/21/2021] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Despite well-known guidelines to prepare adolescents to transition to adult care, research has shown that this is done less than 25% of time in pediatric practice. This quality improvement (QI) project aimed to improve the transition readiness process for all adolescents aged 14-18 at health care maintenance visits. METHODS A multidisciplinary team conducted a quality improvement initiative in a large, urban pediatric academic teaching practice serving a low-income, multi-ethnic population. The team developed transition interventions through successive Plan-Do-Study-Act cycles. They included a formal transition readiness assessment tool, provider-delivered education related to transition readiness, and delivery of a transition brochure for all adolescents. The team used run charts to follow the rate of formal transitions discussions documented in the electronic medical record. RESULTS Over the course of 36 months the outcome measure of provider documented transition readiness discussions increased from 19 to 64% of the time. Over the same course of time, the process measures of transition brochure distribution and completion of the readiness assessment tool increased from 0 to 94% and 0 to 84% respectively. CONCLUSIONS QI methodology and multidisciplinary coordinating to streamline workflow, distribution of transition information, readiness assessment and provider discussion and documentation can be successfully incorporated into a busy primary care setting. By formalizing and standardizing the transition readiness process, pediatric providers can improve young adults' readiness to transition to adult medical care.
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Affiliation(s)
- Lynn F Davidson
- The Children's Hospital at Montefiore, The Pediatric Hospital for the Albert Einstein College of Medicine, United States of America.
| | | | - Elissa Z Faro
- Carver College of Medicine, University of Iowa, United States of America
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