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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jones GL, Hickam T, Wellman C, Modrcin A, Abdelmoity A, Le Pichon JB. Transition to Adult Care in Youth with Epilepsy: One Center's Experience with a Transition Program and Its Integration within Telemedicine. Journal of Pediatric Epilepsy 2020. [DOI: 10.1055/s-0040-1716826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractNeurology patients often have disorders that require life-long care and ongoing treatment. The transition of pediatric neurology patients to adult neurology care, particularly in epilepsy, is an evolving concept that is recognized as important for patients and families. Children's Mercy Hospital, Kansas City has an established transition program that has been integrated into the neurology clinic as a part of standard care. Our experience and utilization of a transition program has provided our patients with a unique opportunity, empowering them to navigate their own care and create a seamless transition to adult neurology. Through a collaboration with the American Academy of Pediatrics and the Department of Health Resources and Services Administration, we have proposed a practice model designed to create a medical home for children and youth with epilepsy in rural underserved areas of Kansas. One of the core end points of this study is transition of care for youth with epilepsy using telemedicine. In this article, we describe our experience with a transition program for epilepsy patients and describe the very early implementation of this program to a telemedicine transition program designed for underserved rural populations.
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Affiliation(s)
- Gina L. Jones
- Department of Pediatric Neurology, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Teresa Hickam
- Transition Program, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Courtney Wellman
- Neurology Clinic, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Ann Modrcin
- Department of Pediatric Rehabilitation, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Ahmed Abdelmoity
- Department of Pediatric Neurology, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Jean-Baptiste Le Pichon
- Department of Pediatric Neurology, Children's Mercy Hospital, Kansas City, Missouri, United States
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Jones MR, Hooper TJ, Cuomo C, Crouch G, Hickam T, Lestishock L, Mennito S, White PH. Evaluation of a Health Care Transition Improvement Process in Seven Large Health Care Systems. J Pediatr Nurs 2019; 47:44-50. [PMID: 31029928 DOI: 10.1016/j.pedn.2019.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/11/2019] [Accepted: 04/07/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE Youth and young adults require systematic planning, transfer and integration into adult healthcare. A national health care transition (HCT) learning network (LN) shared strategies during monthly calls to improve HCTs using Got Transition™'s Six Core Elements. Among LN participants, we conducted a pre-post mixed-methods evaluation of this evidence-informed process improvement framework. DESIGN AND METHODS Leaders from seven health systems in the LN recruited 55 participating practice sites (12 primary care, 43 specialty care, 47 pediatric care, and 8 adult care). Got Transition's Current Assessment (CA) of HCT Activities (possible score: 0-32) assessed implementation of HCT process improvements in all 55 sites at baseline (2015-2017) and again after 12-18 months. Pre-post results were compared overall and by type of practice (primary vs. specialty, pediatric vs. adult). In early 2018, health system leaders qualitatively described factors impacting HCT process implementation. RESULTS Overall, baseline CA scores averaged 10.7, and increased to 17.9 after 12-18 months. Within each clinical setting, scores increased from: 10.8 to 16.5 among 12 primary care sites, 12.8 to 17.1 among 43 specialty sites, 12.4 to 17 among 47 pediatric sites, and 12 to 16.9 among 8 adult sites. All changes reached significance (p < 0.05). Qualitative feedback offered valuable feedback about motivators, facilitators and barriers to HCT process improvement. CONCLUSIONS Participating systems made substantial progress in implementing a structured HCT process consistent with clinical recommendations using the Six Core Elements. PRACTICE IMPLICATIONS The diverse perspectives of participating health systems provide a model for creating sustainable HCT process improvements.
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Affiliation(s)
- Marybeth R Jones
- University of Rochester Medical Center, Department of General Pediatrics, NY, United States of America.
| | - Tisa Johnson Hooper
- Center for Autism and Developmental Disabilities, Henry Ford Medical Center, United States of America.
| | - Carrie Cuomo
- Pediatric Institute, Cleveland Clinic Children's, United States of America.
| | - Gary Crouch
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America.
| | - Teresa Hickam
- Children's Mercy Kansas City, Department of Social Work, MO, United States of America.
| | | | - Sarah Mennito
- Medical University of South Carolina, Departments of Pediatrics and Internal Medicine, SC, United States of America.
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Hickam T, White PH, Modrcin A, McManus M, Cox K. Implementing a Nationally Recognized Pediatric-to-Adult Transitional Care Approach in a Major Children's Hospital. Health Soc Work 2018; 43:3-6. [PMID: 29253121 DOI: 10.1093/hsw/hlx049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Teresa Hickam
- Teresa Hickam, ACSW, LCSW, LSCSW, CCM, is transition program manager, Transition to Adulthood Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108; e-mail: . Patience H. White, MD, MA, is professor of medicine and pediatrics, George Washington School of Medicine and Health Sciences, and codirector of Got Transition, Washington, DC. Ann Modrcin, MD, EMBA, is professor of pediatrics, University of Missouri-Kansas City School of Medicine, and director of the Rehabilitation Medicine and Transition to Adulthood Program, Children's Mercy Kansas City, MO. Margaret McManus, MHS, is president, National Alliance to Advance Adolescent Health, and codirector, Got Transition, Washington, DC. Karen Cox, RN, PhD, is executive vice president and chief operating officer, and V. Fred Burry, MD, and Sandra Hobart Burry Chair in Nursing Advocacy and Leadership, Children's Mercy Kansas City, MO
| | - Patience H White
- Teresa Hickam, ACSW, LCSW, LSCSW, CCM, is transition program manager, Transition to Adulthood Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108; e-mail: . Patience H. White, MD, MA, is professor of medicine and pediatrics, George Washington School of Medicine and Health Sciences, and codirector of Got Transition, Washington, DC. Ann Modrcin, MD, EMBA, is professor of pediatrics, University of Missouri-Kansas City School of Medicine, and director of the Rehabilitation Medicine and Transition to Adulthood Program, Children's Mercy Kansas City, MO. Margaret McManus, MHS, is president, National Alliance to Advance Adolescent Health, and codirector, Got Transition, Washington, DC. Karen Cox, RN, PhD, is executive vice president and chief operating officer, and V. Fred Burry, MD, and Sandra Hobart Burry Chair in Nursing Advocacy and Leadership, Children's Mercy Kansas City, MO
| | - Ann Modrcin
- Teresa Hickam, ACSW, LCSW, LSCSW, CCM, is transition program manager, Transition to Adulthood Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108; e-mail: . Patience H. White, MD, MA, is professor of medicine and pediatrics, George Washington School of Medicine and Health Sciences, and codirector of Got Transition, Washington, DC. Ann Modrcin, MD, EMBA, is professor of pediatrics, University of Missouri-Kansas City School of Medicine, and director of the Rehabilitation Medicine and Transition to Adulthood Program, Children's Mercy Kansas City, MO. Margaret McManus, MHS, is president, National Alliance to Advance Adolescent Health, and codirector, Got Transition, Washington, DC. Karen Cox, RN, PhD, is executive vice president and chief operating officer, and V. Fred Burry, MD, and Sandra Hobart Burry Chair in Nursing Advocacy and Leadership, Children's Mercy Kansas City, MO
| | - Margaret McManus
- Teresa Hickam, ACSW, LCSW, LSCSW, CCM, is transition program manager, Transition to Adulthood Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108; e-mail: . Patience H. White, MD, MA, is professor of medicine and pediatrics, George Washington School of Medicine and Health Sciences, and codirector of Got Transition, Washington, DC. Ann Modrcin, MD, EMBA, is professor of pediatrics, University of Missouri-Kansas City School of Medicine, and director of the Rehabilitation Medicine and Transition to Adulthood Program, Children's Mercy Kansas City, MO. Margaret McManus, MHS, is president, National Alliance to Advance Adolescent Health, and codirector, Got Transition, Washington, DC. Karen Cox, RN, PhD, is executive vice president and chief operating officer, and V. Fred Burry, MD, and Sandra Hobart Burry Chair in Nursing Advocacy and Leadership, Children's Mercy Kansas City, MO
| | - Karen Cox
- Teresa Hickam, ACSW, LCSW, LSCSW, CCM, is transition program manager, Transition to Adulthood Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108; e-mail: . Patience H. White, MD, MA, is professor of medicine and pediatrics, George Washington School of Medicine and Health Sciences, and codirector of Got Transition, Washington, DC. Ann Modrcin, MD, EMBA, is professor of pediatrics, University of Missouri-Kansas City School of Medicine, and director of the Rehabilitation Medicine and Transition to Adulthood Program, Children's Mercy Kansas City, MO. Margaret McManus, MHS, is president, National Alliance to Advance Adolescent Health, and codirector, Got Transition, Washington, DC. Karen Cox, RN, PhD, is executive vice president and chief operating officer, and V. Fred Burry, MD, and Sandra Hobart Burry Chair in Nursing Advocacy and Leadership, Children's Mercy Kansas City, MO
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