| Description |
Background: Young adults with diabetes report that it is difficult to navigate healthcare, and studies show that there is often a delay in the transition from pediatric to adult care. This delay leads to poor patient outcomes, such as increased emergency department visits and hospitalizations. The American Diabetes Association recommends clinics provide transition programs early in adolescence, and support and resources prior to transition. Local Problem: Patients at a pediatric diabetes clinic affiliated with an academic medical center experienced delays in transitioning from pediatric to adult care. The clinic provided transition education that addressed navigating healthcare and encouraged independence, but it was not consistently implemented and standardized amongst staff. Patients, families, and medical staff expressed dissatisfaction with the transition education. Methods: A quality improvement (QI) project to improve education for the transition from pediatric to adult diabetes care was conducted at the urban pediatric diabetes clinic associated with an academic medical center in the Intermountain West. Multiple Plan-Do-Study-Act (PDSA) cycles were used for rapid change and improvement of the new education process. A retrospective chart review and brief interviews were used to assess the usability, feasibility, and satisfaction of the education process pre- and post-implementation. Interventions: A new workflow process was created for the education for transition to adult care. The education material was reviewed, updated, and condensed by the QI team. An education toolkit for transition to adult diabetes care was created that consisted of a workflow chart, education outline, patient checklist, folder with the updated patient education materials, and auto text for charting. The toolkit was piloted by a small group of diabetes educators and then rolled out to all diabetes educators at the main clinic site. The intervention was received by patients 15-18 years old. Results: The small pilot group saw 33 qualifying patients. They documented giving the transition packet 16 times (48.5%), discussing it 19 times (57.6%), specifying which topics they taught 19 times (57.6%), and using the auto text 17 times (51.5%). The clinic site saw 103 qualifying patients and documented giving the transition packet to the patient 70 times (67.9%), discussing transition with them 66 times (64.1%), and specifying which topics they taught 59 times (57.3%). Auto text use increased from 11 times (47.8%) in the first week of full clinic implementation to 17 times (85%) in the last week. Conclusion: Results showed that the new transition process and materials were overall feasible, usable and satisfactory for diabetes educators and adolescent patients. The results also demonstrated that more PDSA cycles may be needed to improve the usability as demonstrated by only 40% of diabetes educators using the transition education auto texts. Because diabetes educators express concern about not having enough time to complete the education, the clinic should consider offering transition-specific education appointments. |
