Implementing a Transition of Care Policy in a Pediatric Primary Care Setting

Background: Many adolescents lose access to specialized or primary medical care during the transition from pediatric to adult care, often due to a lack of healthcare transition interventions and planning by a primary care provider. The Centers for Disease Control and Prevention (CDC) has an established program to integrate transition to adult care into pediatric practices. Implementation of a healthcare transition (HCT) policy and educational resources for pediatric primary care providers will promote care that meets current practice recommendations. Local Problem: There was no active implementation of transition materials at a University of Utah pediatric clinic. This quality improvement project aimed to create a HCT policy and resources to improve provider utilization of CDC transition guidelines and improve adolescent quality of care. Methods: Pre- and post-intervention surveys assessed provider change in attitudes regarding HCT discussion, knowledge and confidence in CDC transition guidelines, as well as feasibility, usability, and satisfaction of the policy. A chart review compared pre- and post-documentation of HCT discussion. Interventions: A HCT policy, charting phrases, and HCT resources were created. Providers received education on policy use, guidelines for HCT discussion, and documentation. Surveys were administered to providers pre-education, post-education, and post-intervention. Results: The pre-intervention score on the HCT Process Measurement Tool was 0/20 and improved to 20/20 at post-intervention. Chart review identified that no patients had a documented HCT discussion at pre-intervention compared to 5.1% (n=13) post-intervention. Provider confidence in discussing a transition policy and resources with patients significantly improved (p=0.005). Overall, the policy and educational resources were found to be useable and feasible, and providers felt satisfied with the interventions. Conclusion: Implementing a HCT policy, provider education, resources, and charting templates are valuable tools in improving provider HCT discussion in practice. Sustained provider education and reminders of HCT resources will increase the value and positive effect of the interventions. To further advance the success of adolescent healthcare transition at this clinic, future studies should include implementation of subsequent steps in the CDC transition program.