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Davidson LF, Doyle MH. Health-care Transition: A Vital Part of Care, Growth, and Change for Pediatric Patients. Pediatr Rev 2021; 42:684-693. [PMID: 34850176 DOI: 10.1542/pir.2020-000422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Preparing all youth for the transition to adult-oriented care, adulthood itself, and a greater responsibility for their own health and health-care is an essential part of pediatric care. This process, typically described as health-care transition, can occur throughout ongoing pediatric health-care to prepare patients for transfer to an adult clinician and integration into adult care. Gaps remain in practice and in outcomes research regarding health-care transition. This review discusses recent literature, details best practices, and recommends guidance and tools to assist pediatric clinicians in providing a smooth transition process and a successful transfer to adult care for youth with and without special health-care needs.
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Affiliation(s)
- Lynn F Davidson
- Division of Academic General Pediatrics, Children's Hospital at Montefiore, Pediatric Hospital of Albert Einstein College of Medicine, Bronx, NY
| | - Maya H Doyle
- Department of Social Work, School of Health Sciences, Quinnipiac University, Hamden, CT
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Spiegel L, Tucker L, Duffy KW, Lalloo C, Hundert A, Bourre-Tessier J, Hazel E, Luca N, Mosher D, Nguyen C, Stringer E, Victor C, Stinson J. Development and validation of the RACER (Readiness for Adult Care in Rheumatology) transition instrument in youth with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:83. [PMID: 34090474 PMCID: PMC8180033 DOI: 10.1186/s12969-021-00579-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current evidence suggests that many adolescents with juvenile idiopathic arthritis (JIA) do not successfully transfer to adult care, which can result in adverse health outcomes. Although a growing number of clinical programs have been designed to support healthcare transition, there is a lack of psychometrically sound instruments to evaluate their impact on development of transition-related knowledge and skills in youth with JIA. The purpose of this study was to develop and validate RACER (Readiness for Adult Care in Rheumatology), a self-administered instrument designed to measure stages of readiness for key transition-related skills in adolescents with JIA. METHODS A phased approach was used to develop and evaluate the validity and reliability of RACER. Phase 1 A was a consensus conference with 19 key stakeholders to inform instrument domains and items. Phase 1B determined initial content validity using a sample of 30 adolescents with JIA and 15 clinical and research experts. Finally, Phase 2 was a prospective cohort study with repeated measures to evaluate the internal consistency, test-retest reliability, construct validity and responsiveness of the instrument within a sample of adolescents with JIA. RESULTS In Phase 1 A, initial item generation yielded a total of 242 items across six domains from the consensus conference, which was subsequently reduced to a 32-item instrument. Phase 1B established the content validity of the instrument in adolescents with JIA. In the Phase 2 study, with a sample of 96 adolescents, the RACER instrument exhibited good internal consistency in five of its six subscales (Cronbach's α > 0.7), and strong test-retest reliability between the first two administrations (ICC = 0.83). It also showed robust convergent validity by highly correlating with measures of self-management (SMSAG, rho = 0.73) and transition (TRANSITION-Q, rho = 0.76). The RACER was not correlated with unrelated measures (discriminant validity; PedsQL, rho = 0.14). The RACER scores increased significantly over time as expected, supporting measure responsiveness. CONCLUSIONS The RACER is a reliable and valid instrument which is sensitive to change for assessing transition readiness in adolescents with JIA.
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Affiliation(s)
- Lynn Spiegel
- Division of Rheumatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lori Tucker
- Division of Rheumatology, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Karen Watanabe Duffy
- Division of Rheumatology, Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
| | - Amos Hundert
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Josiane Bourre-Tessier
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | - Nadia Luca
- Section of Pediatric Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Canada
| | - Dianne Mosher
- University of Calgary and Cumming School of Medicine, Calgary, Canada
| | - Cynthia Nguyen
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Elizabeth Stringer
- Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Canada
| | - Charles Victor
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
- The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, 686 Bay Street, Room 069715, ON, M5G 0A4, Toronto, Canada.
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