P0648 - Improving Provider Comfort with Discussing Insurance Changes During Pediatric to Adult Transitions of Care

BACKGROUND
Most adolescents in the United States do not receive proper transitions of care (ToC) from the pediatric to the adult medical home. This lack of structured health care transition leads to discontinuity of care, risking more complications at higher costs. In this quality improvement study, we assessed existing gaps in the knowledge of topics relevant to this ToC at UI Health among resident and attending physicians, and provided an education-based intervention.

METHODS
A primary needs assessment was used to determine which topic, among a list of important domains for effective ToC, was least understood and routinely addressed by residents and faculty. Pediatrics and Internal Medicine-Pediatrics attendings and residents from an academic pediatrics hospital were surveyed on their knowledge of these domains and the frequency with which they address them. In order to target the identified largest knowledge gap, these groups, along with medical students on their pediatrics clerkship, were additionally surveyed on their knowledge of health insurance relevant to proper ToC. These groups then received a targeted intervention, via an educational conference, on key aspects of eligibility criteria and on application processes for insurance during the transition from parental supplied coverage to self-coverage. The participants were reassessed after this training with the same survey. The results were anonymized before compilation. The data were analyzed via paired T-tests, to compare pre- and post-training data between participants and via analysis of variance to look for correlation between results and timing of intervention relative to training level.

RESULTS
The initial needs assessment showed 79.5% of participants had never received formal ToC training. The mean comfort level addressing ToC of the participants was 3.5 on a Likert scale of 1-5; the mean comfort with addressing health insurance during ToC was significantly lower at 2.3 (p<0.001). The mean scores on the pre- and post-training assessments showed a statistically significant increase (p<0.001) following the intervention across all groups. No significant difference was found between medical students, residents, and attending physicians (p=0.053). Participants showed a 1.38 point increase, on a Likert scale of 1-5, in comfort level on the issue of transitions of care (p= 0.002) after training.

CONCLUSIONS
In this quality improvement study we assessed physician readiness to assist in effective pediatric to adult ToC. Participant comfort with discussing changes in health insurance, as it pertains to this ToC, was found to be significantly below that of other domains. We found that simple educational intervention, specifically an educational conference training, significantly improved provider understanding and comfort with this topic. Given the importance of effective ToC, this QI study demonstrates a successful and tangible first step towards improved ToC outcomes.