186 - Transition of Care Model: Adolescent to Adult Primary Care Process

Poster Number: 186
Publication Number: 186.142

Bushrah Rahman, Elmhurst Hospital, Long Island City, NY, United States; Krishna Suhagia, St. George's University School of Medicine, Jamaica, NY, United States; Thaina Rousseau-Pierre, Mount Sinai School of Medicine, Elmhurst, NY, United States; Janet Siegel, Icahn School of Medicine at Mount Sinai/Elmhurst, Great Neck, NY, United States; M. P. Gonzalez, Icahn School of Medicine at Mount Sinai, Forest Hills, NY, United States; Hadeel Alkhairw, NYC Health+Hospitals, Elmhurst, NY, United States; Marlon E. Brewer, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, United States

Background:
Late adolescence/young adulthood is a critical time to remain connected to primary care services, and the lack of a transition process to adult health services can be a barrier to care. A 2011 AAP report indicates that structured health transition may be associated with improved healthcare outcomes, utilization, and consumer experience. The Got Transition Six Core Elements of Health Care Transition enables a clear guideline to implement the transition stages including the transition policy, assessment, readiness, planning, and transfer of care.

Objective:
This quality improvement (QI) project aims to implement a process promoting universal standards of practice for transitioning from pediatric to adult care through the following goals:

To increase the percentage of patients ages 18+ given a transition policy to 75% within 6 months.
To increase the percentage of patients ages 19+ given a patient readiness assessment to 50% within 6 months.
To increase the percentage of patients ages 20+ given the Adult Primary Care Services (APC) brochure to 50% within 6 months.
To increase the percentage of patients 18 to 22 years who have all 3 aforementioned components of transition of care and a transition referral to APC to 50% within 6 months.

 

Design/Methods:
The Adolescent Health Services (AHS) team initiated a transition protocol to APC for patients ages 18 to 21 years using the electronic medical record, Epic, to carry out and document the completion of each task over three subsequent 12-week PDSA cycles [Figure 1]. Select APC and AHS providers met monthly to discuss progress and adjust protocols as needed. Two PDSA cycles have been completed as outlined in figure 1. Figure 2 demonstrates updates to each PDSA cycle.

Results:
Provider adherence to the complete transition protocol increased with each PDSA cycle for all age groups [Figure 3]. Almost every task of the transition process was completed at a higher percentage from baseline to PDSA 1, and from PDSA 1 to PDSA 2 [Table 1]. By the end of PDSA 2, 53-80% of adolescents between the ages 18-21 years received a transition policy, 38%-66% completed an assessment and 41%-60% received a brochure.
Conclusion(s):
This QI project allowed the AHS providers to implement a transition process providing adolescents from ages 18 to 22 clear guidance on how to properly initiate care in APC. Additionally, collaboration between adult and adolescent clinicians encouraged feedback used to improve processes within each PDSA. Our goal is that patients will have increased readiness to navigate their healthcare needs as they progress into adulthood.

Figure 1.Outlined transition process per age group.
Figure 2.PDSA Cycle information and updates.