180 - Implementation of a Universal Structured Health Care Transition Initiative across a Multi-Site Health System

Poster Number: 180
Publication Number: 180.142

Holly Huang, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Emma Burdekin, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Ariana Gonzalez Rebollar, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Rohini Nott, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Rebecca K. Tsevat, UCLA Health/David Geffen School of Medicine, Los Angeles, CA, United States; Abigail Arons, UCLA Departments of Internal Medicine and Pediatrics, Los Angeles, CA, United States; Janet Ma, University of California, Los Angeles David Geffen School of Medicine, Santa Monica, CA, United States; Susan Duan, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States

Background: Structured health care transitions (HCT), in which adolescents move from a pediatric to an adult model of care, can improve disease-specific outcomes and appropriate utilization of care. Despite recommendations from medical societies, uptake of HCT remains low. Most efforts have focused on youth with special healthcare needs (SHCN) rather than all adolescents, and lack of EHR integration has been identified as a key barrier.

Objective: Assess the early impact of a EHR-integrated HCT initiative for all adolescents in a multi-site primary care setting and elucidate the barriers to its implementation.

Design/Methods: We implemented a structured HCT process for all adolescent well-child visits (ages 12-17) at 5 Internal Medicine-Pediatrics primary care clinics within a health system from 2019 to 2021. The process integrated well-child note templates, Transition Readiness Assessment Questionnaires (TRAQ), and patient education resources into our EHR system, supplemented by physician surveys and education. For patients between 14-17 years of age, TRAQ was administered, scored, and tracked through the EHR. Quantitative analysis included EHR queries for descriptive statistics on TRAQ completion rates, along with data from manual chart review for additional HCT documentation. Qualitative analysis was conducted from the physician survey responses.

Results: Complete data were collected from 3 of the 5 clinics, representing 824 visits. In these 3 clinics, the monthly rate of HCT discussion for 12–17-year-olds increased from 8% before the EHR rollout to 58% 15 months after intervention (n=824, overall=50%). The monthly rate of TRAQ completion for the 14–17-year-olds to which TRAQ was targeted increased from 7% to 57% in the same timeframe (n=584, overall=45%). Barriers to implementing the HCT process included time constraints, insufficient resources, and lack of training regarding HCT.Conclusion(s): We observed an increase in the rates of HCT discussion and TRAQ completion across the participating clinics. Based on the identified barriers, continuing to educate providers regarding HCT resources and streamlining the process of HCT assessment and counseling in a time-efficient manner are critical to the implementation of a successful HCT process. Future work will examine the effect of the structured HCT process on TRAQ scores to evaluate if implementation improves patient-reported transition readiness.
Huang, Holly_CV_PAS.pdf