O2040: Sociodemographic Associations of Transition Readiness Progress in Adolescents: Outcomes of a Formal Congenital Heart Disease Transition Program

Background: Successfully transitioning from pediatric to adult congenital heart disease (CHD) care requires that patients have fundamental knowledge and skills to navigate their lifelong condition. Existing data has demonstrated some transition programs may result in increased CHD knowledge and skills, but data describing sociodemographic associations with transition progress is limited. We aimed to identify the impact of serial transition education visits at the Texas Children’s Hospital (TCH) transition medicine program and determine the sociodemographic associations with transition readiness.

Methods: An existing REDCap database captured adolescent participants in the TCH transition medicine program from 2019 to 2021. Inclusion criteria were pediatric cardiology patients aged 14-21 with either CHD or electrophysiological (EP) diagnoses. Exclusion criteria included inability for serial transition assessments due to significant developmental delay. Patient transition readiness was assessed via: 1. TCH Heart Knowledge Tool (K-Tool) – our questionnaire based on existing transition knowledge assessments in the literature, and 2. Transition-Q – a validated transition skill questionnaire in adolescents with chronic diseases. Sociodemographic variables included sex, race/ethnicity, obesity, primary language, insurance type, CHD severity, EP diagnoses, and genetic diagnoses. Outcome variables included change in K-Tool and Transition-Q scores with successive transition visits. Multivariate mixed linear regression modeling was used to account for repeated measures and patient IDs were incorporated in the model as a random effect while other variables were fixed effects. All multivariable analyses adjusted for age and transition clinic visit number.

Results: A total of 519 patients had 716 serial transition encounters of which, 62% were male, 34.5% were Latino, 8.3% were Black, 21.6% had public insurance, 29.5% had complex CHD, 22.5% had EP diagnoses, and 13% had a genetic syndrome. Increasing transition visit number was an independent predictor of increasing both K-Tool (Figure 1) and Transition-Q scores (Figure 2) regardless of age (p < 0.001). On multivariable K-Tool analyses, patients with public insurance were associated with lower scores (p < 0.01). Patients with EP (p < 0.001) and genetic conditions (p=0.008) were associated with higher scores. Sex, race/ethnicity, primary language, CHD severity, and obesity were not associated with changes in score. On multivariable Transition-Q analyses, patients with public insurance were associated with lower scores (p < 0.01), and increased CHD severity approached significance for lower scores (p= 0.06). Patients with genetic conditions were associated with higher scores (p= 0.02). Sex, race/ethnicity, primary language, EP diagnosis, and obesity were not associated with changes in score.

Conclusion: Regardless of age, increasing transition visits were associated with increased K-Tool and Transition-Q scores. Public insurance remained associated with lower K-Tool and Transition-Q scores. Transition programs are important for skill and knowledge building for all CHD patients, particularly those with lower socioeconomic status.