1
|
Chang JC, Alonzi G, Sears C, Bitencourt N, Hernandez A, Peterson R, Alperin R, Overbury RS, Dela Paz M, Waqar-Cowles LN, White PH, Carandang K, Lawson EF. Transition Guide Dissemination to Foster Patient-Care Team Conversations: A Childhood Arthritis Rheumatology Research Alliance Transition Learning Collaborative Pilot Implementation Study. ACR Open Rheumatol 2024. [PMID: 39381857 DOI: 10.1002/acr2.11753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/31/2024] [Accepted: 09/11/2024] [Indexed: 10/10/2024] Open
Abstract
OBJECTIVE Uptake of evidence-informed health care transition processes among pediatric rheumatologists is low despite poor outcomes of transition from pediatric to adult care. We piloted a learning collaborative model to implement transition guides. We dually assessed implementation outcomes and changes in reported patient-care team discussions about transition. METHODS This was a type II hybrid effectiveness-implementation pilot study of transition guide dissemination to patients at least 14 years old with rheumatic conditions across nine pediatric rheumatology centers in the Childhood Arthritis Rheumatology Research Alliance Transition Learning Collaborative. We evaluated implementation outcomes (feasibility, adaptations, and fidelity) and the proportion of patients surveyed that reported having discussions with their care team regarding transfer planning. RESULTS Six sites were retained through the COVID-19 pandemic (below 70% target). Five out of six sites contributed outcome data (met 80% target) but with substantial heterogeneity in how transition guides were shared (eg, in-person, electronic messages, and posted flyers), and data were collected. The pooled proportion of respondents having discussed transfer planning with their care team was 39% preimplementation (n = 239; 95% confidence interval [CI] 32%-46%) and 55% postimplementation (n = 864; 95% CI 36%-73%). After implementation, there were significant increases in the likelihood of respondents recalling receiving a transition guide (odds ratio [OR] 2.58, 95% CI 1.35-4.92) and discussing transfer planning (OR 2.14, 95% CI 1.30-3.52), adjusted for age and site of care. CONCLUSION Transition guide dissemination is a simple intervention associated with increased awareness among young people with rheumatic conditions and discussions with their care team about transition preparation. The learning collaborative model facilitated identification of several dissemination strategies adaptable to site-specific resources.
Collapse
Affiliation(s)
- Joyce C Chang
- Boston Children's Hospital, Boston, Massachusetts and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Cora Sears
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Rosemary Peterson
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania and Dell Children's Medical Center, Austin, Texas
| | - Risa Alperin
- New York University Langone Health, New York, New York
| | | | - Mariel Dela Paz
- University of California San Francisco, San Francisco, California
| | | | - Patience H White
- Got Transition/The National Alliance to Advance Adolescent Health and The George Washington University, Washington, District of Columbia
| | - Kristine Carandang
- Young Patients' Autoimmune Research & Empowerment Alliance, San Diego, California
| | - Erica F Lawson
- University of California San Francisco, San Francisco, California
| |
Collapse
|
2
|
Perry L, Dunbabin J, Xu X, James S, Lowe J, Acharya S, Steinbeck KS. Service use and glycaemic control of young people with type 1 diabetes transitioning from paediatric to adult care: a 5-year study. Intern Med J 2024; 54:1164-1173. [PMID: 38573020 DOI: 10.1111/imj.16387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/08/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Regular contact with specialist care has been linked to better diabetes outcomes for young people with type 1 diabetes (YPwT1D), but evidence is limited to population-based service usage and outcomes. AIMS This observational 5-year study sought to capture YPwT1D living in the study catchment area (covering metropolitan, regional and rural Australia) as they transitioned to adult-based diabetes healthcare services and to describe their glycaemic control and complication rates, service usage and associated factors. METHODS Records between 2010 and 2014 in a public healthcare specialist diabetes database were extracted, care processes and outcomes were described, and associations were sought between episodes of care (EOC) and potentially predictive variables. RESULTS Annual cohort numbers increased yearly, but without significant differences in demographic characteristics. Each year around 40% had no reported planned specialist care, and the average number of planned EOC decreased significantly year on year. Overall, mean HbA1c levels also reduced significantly, but with higher values recorded for those living in non-metropolitan than metropolitan areas (achieving significance in 3 out of 5 years). Diabetes complication assessments were only reported in 37-46%, indicating one in five with retinopathy and hypertension affecting one in three to five young people. CONCLUSIONS Findings highlight the importance of investment to address the specific needs of adolescents and young adults and demonstrate the need for better support during these vulnerable early years, particularly for non-metropolitan residents. This will entail changes to funding mechanisms, the health workforce and infrastructure, and new models of care to provide equity of access and quality of specialist care.
Collapse
Affiliation(s)
- Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- South Eastern Sydney Local Health District, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Janet Dunbabin
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Xiaoyue Xu
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Steven James
- School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Julia Lowe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shamasunder Acharya
- Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Katharine S Steinbeck
- Discipline of Paediatrics and Child Health, University of Sydney, Camperdown, New South Wales, Australia
- The Sydney Children's Hospital Network, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| |
Collapse
|
3
|
Feeney C, Chandler M, Platt A, Sun S, Setji N, Ming DY. Impact of a hospital service for adults with chronic childhood-onset disease: A propensity weighted analysis. J Hosp Med 2023; 18:1082-1091. [PMID: 37933708 PMCID: PMC11097107 DOI: 10.1002/jhm.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Young adults with chronic childhood-onset diseases (CCOD) transitioning care from pediatrics to adult care are at high risk for readmission after hospital discharge. At our institution, we have implemented an inpatient service, the Med-Peds (MP) line, to improve transitions to adult care and reduce hospital utilization by young adults with CCOD. OBJECTIVE This study aimed to assess the effect of the MP line on length of stay (LOS) and 30-day readmission rates compared to other inpatient services. METHODS This was an observational, retrospective cohort analysis of patients admitted to the MP line compared to other hospital service lines over a 2-year period. To avoid potential confounding by indication for admission to the MP line, propensity score weighting methods were used. RESULTS The MP line cared for 302 patients with CCOD from June 2019 to July 2021. Compared to other service lines, there was a 33% reduction in relative risk of 30-day readmission (26.9% compared to 40.3%, risk ratio = 0.67, 95% confidence interval [CI] 0.55-0.81). LOS was 10% longer for the MP line (event time ratio (ETR): 1.10 95% CI 1.0-1.21) with median LOS 4.8 versus 4.5 days. Patients with sickle cell disease had less of a reduction in 30-day readmissions and longer LOS. CONCLUSION Hospitalization for young adults with CCOD on a MP service line was associated with lower 30-day readmission rates and longer LOS than hospitalization on other services. Further research is needed to assess which components of the line most contribute to decreased utilization.
Collapse
Affiliation(s)
- Colby Feeney
- Duke University School of Medicine, Department of Medicine
- Duke University School of Medicine, Department of Pediatrics
| | - Mark Chandler
- Duke University School of Medicine, Department of Medicine
- Duke University School of Medicine, Department of Pediatrics
| | - Alyssa Platt
- Duke University, Department of Biostatistics and Bioinformatics
| | - Shifeng Sun
- Duke University, Department of Biostatistics and Bioinformatics
| | - Noppon Setji
- Duke University School of Medicine, Department of Medicine
- Duke University School of Medicine, Department of Pediatrics
| | - David Y. Ming
- Duke University School of Medicine, Department of Medicine
- Duke University School of Medicine, Department of Pediatrics
- Duke University School of Medicine, Department of Population Health Sciences
| |
Collapse
|
4
|
Zurynski Y, Carrigan A, Meulenbroeks I, Sarkies MN, Dammery G, Halim N, Lake R, Davis E, Jones TW, Braithwaite J. Transition models of care for type 1 diabetes: a systematic review. BMC Health Serv Res 2023; 23:779. [PMID: 37474959 PMCID: PMC10360292 DOI: 10.1186/s12913-023-09644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/04/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Managing the care regimen for Type 1 Diabetes is challenging for emerging adults, as they take on greater responsibility for self-management. A diverse range of models of care have been implemented to improve safety and quality of care during transition between paediatric and adult services. However, evidence about acceptability and effectiveness of these is limited. Our aim was to synthesise the evidence for transition models and their components, examine the health related and psychosocial outcomes, and to identify determinants associated with the implementation of person-centred models of transition care. METHOD We searched Medline, CINAHL, EMBASE and Scopus. Peer reviewed empirical studies that focused on T1D models of care published from 2010 to 2021 in English, reporting experimental, qualitative, mixed methods, and observational studies were included. RESULTS Fourteen studies reported on health and psychosocial outcomes, and engagement with healthcare. Three key models of care emerged: structured transition education programs (6 studies), multidisciplinary team transition support (5 studies) and telehealth/virtual care (3 studies). Compared with usual practice, three of the six structured transition education programs led to improvements in maintenance of glycaemic control, psychological well-being, and engagement with health services. Four MDT transition care models reported improved health outcomes, and improved engagement with health services, however, three studies reported no benefit. Reduced diabetes related stress and increased patient satisfaction were reported by two studies, but three reported no benefit. Telehealth and virtual group appointments improved adherence to self-management and reduced diabetes distress but did not change health outcomes. CONCLUSIONS Although some health and psychosocial benefits are reported, the results were mixed. No studies reported on T1D transition model implementation outcomes such as acceptability, adoption, and appropriateness among clinicians or managers implementing these models. This gap needs to be addressed to support future adoption of successful models.
Collapse
Affiliation(s)
- Yvonne Zurynski
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia.
| | - Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
| | - Isabelle Meulenbroeks
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Mitchell N Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
| | - Genevieve Dammery
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Nicole Halim
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Rebecca Lake
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
| | - Elizabeth Davis
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Timothy W Jones
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Jeffrey Braithwaite
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
| |
Collapse
|
5
|
Hospital presentations with diabetic ketoacidosis: A retrospective review. Australas Emerg Care 2023; 26:1-6. [PMID: 35817716 DOI: 10.1016/j.auec.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is a significant source of preventable episodes of care and cost. This study aimed to describe the demographic and clinical characteristics of people with type 1 diabetes (T1D) presenting to the Emergency Department (ED) with DKA in an area of socio-economic deprivation in metropolitan Queensland, Australia, and to describe factors associated with hospital admission and re-presentation in this population. METHODS This was a retrospective descriptive analysis of routine healthcare record data for January 2015-December 2019. People with T1D were identified through hospital discharge codes. RESULTS More than half (n = 165) the estimated local T1D population (n = 317) experienced an index ED presentation for DKA; mean±SD age at ED presentation was 31.1 + /- 19.3 years, 126 (76.4%) were aged ≥ 16 years and 20 (12.1%) were newly diagnosed. Index DKA presentation was significantly associated with female sex (p = 0.04) but no other demographic or geographic variables. More than half the presentations (n = 92, 55.8%) occurred outside regular business hours. Twenty-three representations occurred within 90 days, associated with older age (p = 0.045) and lower residential socio-economic score (p = 0.02). CONCLUSION Findings highlight the frequent problem of DKA and the importance of socio-economic influences. This flags the need and opportunity to improve support to people with T1D to promote diabetes self-care.
Collapse
|
6
|
Chai TYL, Farrell K, Holmes-Walker DJ. Use of continuous subcutaneous insulin infusion versus multiple daily injections in emerging adults with type 1 diabetes is associated with better clinical engagement but not glycaemic control. Intern Med J 2023; 53:255-261. [PMID: 34561942 DOI: 10.1111/imj.15539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited studies have compared outcomes between emerging adults with type 1 diabetes mellitus (T1D) attending a diabetes transition support programme using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). AIMS To assess glycaemic control and service utilisation in emerging adults with T1D on MDI or CSII attending a young adult diabetes clinic (YAC). METHODS A retrospective cohort analysis was conducted from January 2013 to December 2015. Data collected included clinic visits per year, after-hours mobile telephone use, diabetic ketoacidosis (DKA) admissions and all HbA1c levels. Independent t-test was used to compare continuous variables whilst Pearson's Chi-squared test was used for categorical variables. Linear mixed effects models explored mean changes in HbA1c levels over time. RESULTS Over 3 years, 318 youth with T1D (176 MDI, 121 CSII, 21 switched from MDI to CSII) attended our YAC. Aggregated mean HbA1c levels remained similar between modalities (CSII 9.1% vs MDI 9.3%; P = 0.23); however, mean change in HbA1c at 3 years was significantly increased in CSII users at 0.55% (95% CI 0.15-0.95; P < 0.01) compared with no significant change in MDI users. Clinic visits per year were improved in CSII users (CSII 2.8 vs MDI 2.5; P = 0.02), while DKA admissions remained similar between MDI and CSII users (3.6 admissions per 100 patient-years). CONCLUSION In our YAC cohort, glycaemic control in CSII and MDI users was similar but well below recommended international glycaemic targets (HbA1c level < 7.0%). Despite increased clinical engagement occurring in CSII users, glycaemic deterioration was observed over the 3 years.
Collapse
Affiliation(s)
- Thora Y L Chai
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Diabetes Transition Support Program, Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kaye Farrell
- Diabetes Transition Support Program, Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Deborah J Holmes-Walker
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Diabetes Transition Support Program, Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
7
|
D'Amico RP, Pian TM, Buschur EO. Transition From Pediatric to Adult Care for Individuals With Type 1 Diabetes: Opportunities and Challenges. Endocr Pract 2022; 29:279-285. [PMID: 36528273 DOI: 10.1016/j.eprac.2022.12.006] [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: 09/22/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Type 1 diabetes (T1D) is a chronic disease with patients across the age spectrum that has high potential for morbidity and mortality. Unfortunately, patients transitioning from pediatric to adult care continue to demonstrate worsened glycemic control in part due to lack of understanding of transition of care best practices. METHODS This review highlights the impact of existing transition of care interventions, assessment tools, and other recently published strategies for providers to consider to improve care of adolescent and young adult (AYA) patients with T1D in both hospital- and clinic-based settings. RESULTS Many barriers impact patients with T1D during the transition period and disparities by race, sex, insurance status, and comorbid illness persist. As diabetic care continues to evolve and the prevalence of adolescents and young adults living with T1D increases, an intentional approach to transition of care is more pressing than ever. While current literature on transition of care models is limited, many show promise in improving clinic attendance and decreasing hospitalization. There are critical discussions that providers should lead with AYA patients to improve their outcomes and increase diabetes self-management, such as re-addressing carbohydrate counseling, sleep hygiene, and reproductive planning. CONCLUSION While further research on transition of care is needed, many care models offer the promise of improved T1D outcomes, enhancements in our approach to care, and increased value for our health care system at large.
Collapse
Affiliation(s)
- Rachel P D'Amico
- Division of General Internal Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Timothy M Pian
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Elizabeth O Buschur
- Division of Endocrinology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
| |
Collapse
|
8
|
Bailey K, Lee S, de Los Reyes T, Lo L, Cleverley K, Pidduck J, Mahood Q, Gorter JW, Toulany A. Quality Indicators for Youth Transitioning to Adult Care: A Systematic Review. Pediatrics 2022; 150:188245. [PMID: 35665828 DOI: 10.1542/peds.2021-055033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Transition from pediatric to adult care is associated with adverse health outcomes for many adolescents with chronic illness. We identified quality indicators for transition to adult care that are broadly applicable across chronic illnesses and health systems. METHODS Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature were searched, covering earliest available date to July 2021. The Gray Matters framework was used to search gray literature. Two independent reviewers screened articles by title and abstract, followed by full-text review. Disagreements were resolved by a third reviewer. Studies were included that identified quality indicators developed via consensus-building methods. Indicators were organized into a framework categorized by illness specificity, level of care, Donabedian model, and Institute of Medicine quality domain. Appraisal of Guidelines for Research and Evaluation tool was used for critical appraisal. RESULTS The search identified 4581 articles, of which 321 underwent full-text review. Eight peer-reviewed studies and 1 clinical guideline were included, identifying 169 quality indicators for transition. Of these, 56% were illness specific, 43% were at the patient level of care, 44% related to transition processes, and 51% were patient centered and 0% equity focused. Common indicator themes included education (12%), continuity of care (8%), satisfaction (8%), and self-management/self-efficacy (7%). The study was limited by quality indicators developed through consensus-building methodology. CONCLUSIONS Although most quality indicators for transition were patient-centered outcomes, few were informed by youth and parents/caregivers, and none focused on equity. Further work is needed to prioritize quality indicators across chronic illness populations while engaging youth and parents/caregivers in the process.
Collapse
Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine.,Institute of Health Policy, Management and Evaluation
| | - Stephanie Lee
- Department of Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Adolescent Medicine, Monash Children's Hospital, Melbourne, Australia
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Kristin Cleverley
- Temerty Faculty of Medicine.,Lawrence S. Bloomberg School of Nursing, University of Toronto, Toronto, Ontario, Canada.,Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | - Jan Willem Gorter
- Department of Rehabilitation, Physical Therapy Science & Sports.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,CanChild, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Alene Toulany
- Temerty Faculty of Medicine.,Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Patel S, Farkash C, Simmons D. Type 1 diabetes management and hospitalisation in the over 25's at an Australian outer urban diabetes clinic. BMC Endocr Disord 2022; 22:143. [PMID: 35641973 PMCID: PMC9158186 DOI: 10.1186/s12902-022-01057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS To describe clinic management and referral pathways among adults with type 1 diabetes (T1D) aged > 25 years attending a public outpatient diabetes service. METHODS Retrospective cohort study of people with T1D aged > 25 years seen by endocrinologists in one Australian urban public outpatient in 2017. Electronic and paper medical records were reviewed using a dataset adapted from the UK National Institute for Health and Care Excellence 2015 guidelines. RESULTS Among the 111 people with T1D (mean age 41 ± 13 years, 55% men, mean body mass index 27.1 ± 5.6 kg/m2), mean HbA1c was 8.1 ± 1.9% (66 ± 19 mmol/mol) (lower than the Australian National Diabetes Audit: 8.5%/69 mmol/mol) with 25.5% meeting the guideline target of < 53 mmol/mol (7.0%). Most people had seen a diabetes educator (80.2%) or dietitian (73.0%) and had complication screening. Complication rates were high (nephropathy 20.4%, retinopathy 27.4%, peripheral neuropathy 30.1%, ischaemic heart disease/acute infarction 10.5%). Overall, 27% of referrals occurred following an acute inpatient admission or emergency department presentation and 13% for management of diabetes in pregnancy. CONCLUSIONS A high proportion of people with T1D accessed public specialist care either during pregnancy or after a largely avoidable acute glycaemia-related hospital presentation. Subsequent care was in line with national specialist standards. This area has a "wait for acute event" rather than "complication prevention" model of care, associated with under-referral to the local multidisciplinary specialist service. Understanding how widespread this model of care is, and ways to reduce its prevalence, are urgently required.
Collapse
Affiliation(s)
- Shivani Patel
- Department of Diabetes & Endocrinology, Campbelltown Hospital, Campbelltown, NSW, Australia
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, Australia
| | - Celine Farkash
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - David Simmons
- Department of Diabetes & Endocrinology, Campbelltown Hospital, Campbelltown, NSW, Australia.
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, Australia.
| |
Collapse
|
10
|
Casseus M, Cheng J. Variations in Healthcare Transition Preparation Among Youth With Chronic Conditions. Am J Prev Med 2022; 62:e275-e283. [PMID: 34949508 DOI: 10.1016/j.amepre.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Youth with special healthcare needs have low rates of healthcare transition services, which can affect lifelong functioning and quality of life. This study examines the variations in receipt of healthcare transition services among youth with special healthcare needs. METHODS Data from the 2016-2018 National Survey of Children's Health (N=102,341) were analyzed in 2021. Receipt of healthcare transition services by youth with select health conditions was compared with youth with other special healthcare needs. Bivariate and multivariable analyses assessed the associations between the receipt of healthcare transition services, sociodemographic characteristics, and health conditions. RESULTS Among youth with special healthcare needs, the prevalence of receiving healthcare transition services was lowest among youth with speech or other language disorders (8.5%), intellectual disabilities (9.4%), and autism spectrum disorder (11.1%). Low prevalence of receiving healthcare transition services was also observed for youth with developmental delays (12.6%), learning disabilities (14.2%), and behavior or conduct problems (15.5%). Youth with developmental delays (AOR=0.70, 95% CI=0.52, 0.95), intellectual disabilities (AOR=0.45, 95% CI=0.26, 0.78), learning disabilities (AOR=0.77, 95% CI=0.60, 0.99), autism spectrum disorder (AOR=0.60, 95% CI=0.41, 0.86), and speech or other language disorders (AOR=0.48, 95% CI=0.32, 0.72) had lower odds of receiving healthcare transition services than youth with other special healthcare needs. CONCLUSIONS Findings suggest that the receipt of healthcare transition services varies substantially by the type of chronic health condition and highlight the need for increased healthcare transition services for youth with special healthcare needs, especially for youth with neurodevelopmental disabilities and speech or other language disorders.
Collapse
Affiliation(s)
- Myriam Casseus
- Research Center, Children's Specialized Hospital, New Brunswick, New Jersey.
| | - JenFu Cheng
- Physiatry Section, Children's Specialized Hospital, Mountainside, New Jersey; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey; Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| |
Collapse
|
11
|
The added value of transition programs in Dutch diabetes care: A controlled evaluation study. J Pediatr Nurs 2022; 62:155-163. [PMID: 34419327 DOI: 10.1016/j.pedn.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The desirability of evaluating transition programs is widely acknowledged. This study aimed to explore the added value of transitional care investments for young adults with type 1 diabetes mellitus. DESIGN AND METHODS Based on qualitative data, two groups of diabetes teams were created through cluster analysis: paying more (HI-ATT) versus less attention (LO-ATT) to transitional care. Retrospective controlled evaluation included chart reviews on healthcare use and clinical outcomes; and a survey on young adults' experiences, satisfaction with care, and self-management skills. RESULTS Data from 320 patients in fifteen diabetes teams were collected; 123 young adults (38.4%) completed a questionnaire. Self-reported outcomes showed that young adults treated by a HI-ATT team felt better prepared for transfer (p < .05). Self-management outcomes did not differ between groups. HI-ATT teams had more scheduled consultations in the year after transfer (p < .05); only 10.6% of all measurements had reached targeted HbA1c scores. CONCLUSIONS Current transitional care investments in Dutch diabetes care did not lead to notable improvements in experiences and outcomes, except for preparation for transfer. The period after transfer, however, is just as important. Attention is required for parent involvement. PRACTICE IMPLICATIONS Transitional care investments should extend beyond the transfer. By educating young adults about the importance of regular clinic attendance and introducing additional person-centered consultations in adult care, nurses may help ensure continuity of care. Nurses could also introduce support programs for parents to prepare for the transition and their change in role, taking into account their continuing partnership.
Collapse
|
12
|
Yuyama Y, Kawamura T, Nishikawa-Nakamura N, Hotta Y, Hashimura K, Hashimoto T, Hirose M, Higashide T, Hamazaki T. Relationship Between Bedside Ketone Levels and Time to Resolution of Diabetic Ketoacidosis: A Retrospective Cohort Study. Diabetes Ther 2021; 12:3055-3066. [PMID: 34628606 PMCID: PMC8586106 DOI: 10.1007/s13300-021-01167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION There is no information on the factors that influence the time required to induce resolution of diabetic ketoacidosis (DKA). New methods are currently available for bedside measurement of serum 3-hydroxybutyrate (3HB). The aim of this study was to determine the relationship between serum 3HB and the time to DKA resolution. METHODS We reviewed the medical records of patients with type 1 diabetes (T1D) and a history of DKA who were admitted to the Department of Pediatrics, Osaka City University Hospital, between November 2008 and October 2018. DKA resolution was defined as 3HB below 1.0 mmol/L as measured by a bedside ketone meter. RESULTS Data of 52 T1D-DKA episodes were analyzed (median age, 8.0 years; 20 male patients; 32 female patients; new T1D diagnosis, n = 13; established diagnosis, n = 39). In all cases, correction of serum 3HB was an important aspect of T1D management. The median time to DKA resolution (defined as the time from the start of insulin infusion until the fall of 3HB level to below 1.0 mmol/L) was 11 and 10 h in new and established T1D cases, respectively. 3HB on admission and the required insulin infusion dose per body weight, but not blood pH level on admission, correlated with time to DKA resolution. There was no relationship between blood pH level and 3HB on admission. CONCLUSIONS Our results showed that DKA resolution could be achieved within 10-11 h when DKA treatment is guided by bedside 3HB monitoring without any severe complications. Blood 3HB level is a potentially suitable marker for the severity and resolution of DKA.
Collapse
Affiliation(s)
- Yoshihiko Yuyama
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Asahi-cho 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Tomoyuki Kawamura
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Asahi-cho 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
| | - Naoko Nishikawa-Nakamura
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Asahi-cho 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Yuko Hotta
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Asahi-cho 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Kayako Hashimura
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Asahi-cho 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Tomomi Hashimoto
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Asahi-cho 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Masakazu Hirose
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Asahi-cho 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Takashi Higashide
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Asahi-cho 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| | - Takashi Hamazaki
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Asahi-cho 1-4-3, Abeno-ku, Osaka City, Osaka, 545-8585, Japan
| |
Collapse
|
13
|
Rueter P, Farrell K, Phelan H, Colman P, Craig ME, Gunton J, Holmes-Walker DJ. Benchmarking care outcomes for young adults with type 1 diabetes in Australia after transition to adult care. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00295. [PMID: 34505422 PMCID: PMC8502218 DOI: 10.1002/edm2.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022]
Abstract
AIM To determine advantages conferred by a youth-specific transition clinic model for young adults with type 1 diabetes (T1D) at Westmead Hospital (WH) as compared with Australian registry data. METHODS Prospectively collected data included age, diabetes duration, visit frequency, post code, BMI, mode of insulin delivery, continuous glucose monitoring, HbA1c, albumin creatinine ratio, BP, retinopathy and diabetic ketoacidosis (DKA) for all WH T1D clinic attendees aged 16-25 between January 2017 and June 2018 (n = 269). Results were compared with data collected during the same time period from 2 separate Australian data registries, one longitudinal (Australasian Diabetes Data Network, ADDN) and one a spot survey (the Australian National Diabetes Audit, ANDA). RESULTS Across the three cohorts, HbA1c was similar (respectively, WH, ADDN, ANDA; 8.7%[72mmol/mol], 8.7%[72mmol/mol], 8.5%[69mmol/mol]) and HbA1c was significantly higher in young adults <21 years (8.7-8.9%[73-75mmol/mol]) as compared with ≥21 years (8.5%[69mmol/mol], p < .002). In the WH cohort, median interval between visits was shorter than in ADDN (4.5 vs. 9.0 months) and DKA was lower (respectively, 3.6 and 9.2/100 patient years; p < .001). CONCLUSIONS While suboptimal HbA1c was recorded in all centres, the WH model of care saw increased attendance and reduced admissions with DKA as compared with other Australian adult centres.
Collapse
Affiliation(s)
- Phidias Rueter
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Kaye Farrell
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
| | - Helen Phelan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Peter Colman
- Department Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, NSW, Australia.,Charles Perkins Centre Westmead, University of Sydney, Sydney, NSW, Australia.,School of Women's and Children's Health, University of NSW, Sydney, NSW, Australia
| | - Jenny Gunton
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia.,Westmead Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - D Jane Holmes-Walker
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
| | | |
Collapse
|
14
|
Eledrisi MS, Elzouki AN. Management of Diabetic Ketoacidosis in Adults: A Narrative Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 8:165-173. [PMID: 32952507 PMCID: PMC7485658 DOI: 10.4103/sjmms.sjmms_478_19] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/20/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022]
Abstract
Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency and causes the greatest risk for death in patients with diabetes mellitus. DKA more commonly occurs among those with type 1 diabetes, yet almost a third of the cases occur among those with type 2 diabetes. Although mortality rates from DKA have declined to low levels in general, it continues to be high in many developing countries. DKA is characterized by hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement as well as identification and treatment of the underlying precipitating event along with frequent monitoring of patient's clinical and laboratory states. The most common precipitating causes for DKA include infections, new diagnosis of diabetes and nonadherence to insulin therapy. Clinicians should be aware of the occurrence of DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors. Discharge plans should include appropriate choice and dosing of insulin regimens and interventions to prevent recurrence of DKA. Future episodes of DKA can be reduced through patient education programs focusing on adherence to insulin and self-care guidelines during illness and improved access to medical providers. New approaches such as extended availability of phone services, use of telemedicine and utilization of public campaigns can provide further support for the prevention of DKA.
Collapse
Affiliation(s)
- Mohsen S Eledrisi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Abdel-Naser Elzouki
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| |
Collapse
|
15
|
Schmidt A, Ilango SM, McManus MA, Rogers KK, White PH. Outcomes of Pediatric to Adult Health Care Transition Interventions: An Updated Systematic Review. J Pediatr Nurs 2020; 51:92-107. [PMID: 31981969 DOI: 10.1016/j.pedn.2020.01.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
PROBLEM A previous systematic review found that health care transition (HCT) interventions result in positive outcomes related to population health, patient experience of care, and utilization. Since its publication, new national statistics, updated professional guidance, and a growing body of published literature on HCT have prompted the need for an updated systematic review that aims to examine outcomes of the latest pediatric-to-adult HCT interventions. ELIGIBILITY CRITERIA Eligible studies were published in English between May 2016 and December 2018, described HCT interventions for youth moving from pediatric to adult outpatient health care, quantitative in design, and peer-reviewed. SAMPLE Nineteen articles from a literature search of CINAHL, OVID Medline, PubMed, Scopus, Web of Science were included in this review. RESULTS All included studies examined youth with special health care needs. Most of the positive outcomes identified were related to population health, followed by improvements in utilization. All studies mentioned transfer assistance, most described transition planning supports, and almost half reported on integration into adult care. CONCLUSIONS This review strengthens the evidence that a structured HCT process for youth with special health care needs can show improvements in adherence to care, disease-specific measures, quality of life, self-care skills, satisfaction with care, health care utilization, and HCT process of care. IMPLICATIONS Future research studies should utilize interventions that incorporate all HCT components (planning, transfer, and integration) and assess provider experience of care as well as cost of care.
Collapse
Affiliation(s)
- Annie Schmidt
- The National Alliance to Advance Adolescent Health/Got Transition, ®Washington, D.C., United States of America.
| | - Samhita M Ilango
- The National Alliance to Advance Adolescent Health/Got Transition, ®Washington, D.C., United States of America
| | - Margaret A McManus
- The National Alliance to Advance Adolescent Health/Got Transition, ®Washington, D.C., United States of America
| | - Katherine K Rogers
- Independent Research Consultant, Washington, D.C., United States of America
| | - Patience H White
- The National Alliance to Advance Adolescent Health/Got Transition, ®Washington, D.C., United States of America
| |
Collapse
|
16
|
Lu M, Yee BJ, Fitzgerald DA. Transition to adult care in sleep medicine. Paediatr Respir Rev 2020; 33:9-15. [PMID: 31806562 DOI: 10.1016/j.prrv.2019.09.008] [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: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 11/15/2022]
Abstract
More children with chronic and complex care needs are transitioned to adulthood due to advancements in medical technology including the use of non-invasive ventilation [NIV] at home and innovative medical therapies. Sleep medicine is becoming a common and at times vital component of the management plan. Various challenges are experienced in transitioning sleep patients depending on the underlying condition. These include the direct conflict between the desires of a young person for independence and their declining ability to provide self-care in neuromuscular patients, the behavioural challenges inherent in the management of children with various syndromes and the funding of equipment, care needs and multidisciplinary team input in an already resource limited adult setting. These patients should be transitioned in an early and coordinated approach following core principles of transition. Ongoing advocacy is required to raise awareness of the increased trend for technology supported young people being transitioned. Further research is required to track and assess the transition process in patients with various sleep conditions.
Collapse
Affiliation(s)
- Mimi Lu
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Brendon J Yee
- Centre for Sleep and Chronobiology (CIRUS), Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
17
|
Farrell K, Brunero S, Holmes-Walker DJ, Griffiths R, Salamonson Y. Self-management of sick days in young people with type 1 diabetes enhanced by phone support: A qualitative study. Contemp Nurse 2019; 55:171-184. [PMID: 31271107 DOI: 10.1080/10376178.2019.1640620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims and Objectives: The aim of this paper was to evaluate the impact of phone support on sick day management of young people with type 1 diabetes. Method: Qualitative exploratory study to understand the usage of a phone support service available, 8am to 8.30pm, seven days a week. Inclusion criteria were: (a) young people with type 1 diabetes who attend an age-specific service; (b) experienced acute diabetes crisis. Interviews were coded for themes using QSR NVivo™ Version 11 software. Findings were examined through the theoretical lens of the Health Belief Model. Results: Of 20 eligible individuals, 8 participated in the study. Five avoided emergency presentation by accessing the phone support service; three who did not were admitted for diabetic ketoacidosis. The interviews generated 3 major themes: (a) self-efficacy, (b) cues to action, (c) susceptibility. Conclusion: Enhancing self-efficacy and promoting confidence to seek help early during an acute health crisis enables young people to effectively self-manage and avoid hospitalization.
Collapse
Affiliation(s)
- Kaye Farrell
- a Clinical Nurse Consultant, Westmead Hospital , Westmead, PO Box 533, Wentworthville , NSW 2145 , Australia.,b School of Nursing and Midwifery, Western Sydney University , Locked Bag 1797, Penrith , NSW 2751 , Australia
| | - Scott Brunero
- c Clinical Nurse Consultant, Mental Health Liaison Nursing, School of Nursing and Midwifery, Prince of Wales Hospital, Western Sydney University , Locked Bag 1797, Penrith , NSW 2751 , Australia.,d Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research , Liverpool , NSW , Australia
| | - Deborah Jane Holmes-Walker
- e Westmead Hospital , Westmead, PO Box 533, Wentworthville , NSW 2145 , Australia.,f Sydney University Medical School , Sydney , NSW , Australia
| | - Rhonda Griffiths
- b School of Nursing and Midwifery, Western Sydney University , Locked Bag 1797, Penrith , NSW 2751 , Australia
| | - Yenna Salamonson
- b School of Nursing and Midwifery, Western Sydney University , Locked Bag 1797, Penrith , NSW 2751 , Australia.,d Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research , Liverpool , NSW , Australia
| |
Collapse
|
18
|
White PH, Cooley WC, Boudreau ADA, Cyr M, Davis BE, Dreyfus DE, Forlenza E, Friedland A, Greenlee C, Mann M, McManus M, Meleis AI, Pickler L. Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics 2018; 142:peds.2018-2587. [PMID: 30348754 DOI: 10.1542/peds.2018-2587] [Citation(s) in RCA: 424] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Risk and vulnerability encompass many dimensions of the transition from adolescence to adulthood. Transition from pediatric, parent-supervised health care to more independent, patient-centered adult health care is no exception. The tenets and algorithm of the original 2011 clinical report, "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home," are unchanged. This updated clinical report provides more practice-based quality improvement guidance on key elements of transition planning, transfer, and integration into adult care for all youth and young adults. It also includes new and updated sections on definition and guiding principles, the status of health care transition preparation among youth, barriers, outcome evidence, recommended health care transition processes and implementation strategies using quality improvement methods, special populations, education and training in pediatric onset conditions, and payment options. The clinical report also includes new recommendations pertaining to infrastructure, education and training, payment, and research.
Collapse
Affiliation(s)
- Patience H. White
- Got Transition/The National Alliance to Advance Adolescent Health and Department of Medicine and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and
| | - W. Carl Cooley
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|