| Description |
Background: Transitioning from pediatric to adult healthcare is a crucial adjustment for adolescents and young adults (AYA). Healthcare transition (HCT) involves moving from pediatric care to the adult healthcare system. AYAs are frequently lost to care and do not undergo routine well-person visits that include healthcare transition preparation, especially when they do not perceive the benefit of such visits. Essential screenings, anticipatory guidance, and preventative care should occur during these early adult years, which can significantly impact a person's health trajectory and relationship with healthcare. Local Problem: With approximately 29% of the total population under 18, Utah has one of the youngest populations in the United States. Nearly half of all children in Utah are insured by Medicaid, providing healthcare access to a large population. Medicaid insures teens and young adults with complex healthcare needs and social determinants of health (SDoH) deficits. Without addressing the transition from pediatric to adult care in people insured by Medicaid, a large population will lack the necessary health literacy to understand and access adult healthcare services. Delay and neglect of adolescent healthcare can lead to increasingly severe health problems when AYAs obtain delayed care. The initiative aims to improve pediatric providers' documented HCT interventions using evidence-based guidelines to improve healthcare outcomes. Methods: The project utilized the Johns Hopkins Evidence-Based Practice Model (JHEBP) to guide improvements in HCT from pediatric to adult care. The initiative was based on a need identified by providers in a local pediatric practice. The practice gap led to developing a practice question, which guided the search for evidence supporting best practice. We synthesized evidence from peer-reviewed articles and national organizations and tailored information into a clinical practice guideline (CPG) specific to the local pediatric clinic's Medicaid-insured population. Participants included twelve providers and approximately forty support staff, including medical assistants, receptionists, and administrators. The project tracked HCT CPG implementation over eight weeks. We refined the evidence-based practice improvement guideline through rapid cycle iterations involving inquiry, reflection, and evaluation; ongoing informal surveys informed rapid cycle changes of the medical team and observation of EHR data. Interventions: We evaluated the change in HCT intervention documentation and provider attitudes. We analyzed qualitative and quantitative survey data to identify feasibility, usability, satisfaction, future needs, and areas for improvement. The team tracked the uptake of use and near-misses, which informed improvements before disseminating the CPG to the broader clinical group. Results: Pre- and post-surveys demonstrated significant improvements in staff knowledge (U=10, p<0.05), while feasibility, usability, and satisfaction were variable. During the two months of implementation, 17% of all age 14+ well-child checks had documented HCT interventions; the chi-square test of independence (χ²= 29.5 with p < 0.00001) showed a significant increase in documented interventions. Conclusion: This initiative adapted and implemented a CPG that improved documented healthcare transition interventions in the pilot clinic. Additional initiatives are needed to address structured transitions, consistent measures, and longitudinal outcomes. |
