PC2144: Development and Implementation of Systemic Transition from Pediatrics Care to Adult Care in Residency Clinics: A Quality Improvement Project

Purpose/Objectives: The American Academy of Pediatrics (AAP) and American College of Physicians (ACP) endorsed Gottransition.org recommendations regarding transition from pediatrics to adult care. At Kansas University School of Medicine – Wichita Pediatrics residency clinic (KUSM-W Peds), when this project started, there was no systemic assessment, mechanism, or tracking of transitions to adult care, including to KUSM-W Internal Medicine residency clinic (KUSM-W IM).

Design/Methods: The Gottransition.org transition policy template was adapted to KUSM-W Peds and posted in the clinic. A validated survey, STARx, and modified template were introduced to ≥ 15 years well visits to measure transition readiness and to prompt practitioners to discuss it.

To facilitate transfer between KUSM-W Peds and IM, a referral process using Redcap was established. Pediatric providers scanned a QR code attached to a Redcap form which triggered an alert to KUSM-W IM to schedule them. (See Figure 1)

Feedback was obtained approximately monthly and chart reviewed after month of implementation and then every 3 months.

Results: Informal verbal feedback with pediatric staff and providers indicated lack of knowledge regarding the STARx and the transfer processes. There were 313 annual visits from KUSM-W Peds clinic aged 15 and older over a 7-month period. Transitions were discussed or STARx was completed in 67 encounters (21%) with transition discussion only 15.9%, STARx only 5.4%, and both 4.2% (See Figure 2). Seven pediatric patients were referred and 4 were scheduled and seen in KUSM-W IM but at least 2 of the successful referrals required additional intervention. Of note, 1 parent of a patient was referred to KUSM-W IM using this process.

There was insufficient data for further statistical analyses.

Conclusion/Discussion: The systemic process of transition of care at KUSM-W remains a work in progress. The pandemic led to limited number of annual visits which reduced the number of potential referrals and IT support for the project rollout. The focus on ages 15 years and older for this project was based on local concerns that 12 was too young to start these conversations. Throughout the project, providers felt that the length of the STARx was a significant barrier, limiting its ability to be used long-term. It is unclear if the template changes lead to any differences in provider practices. There was no process to easily track all patient referrals to adult care (not just KUSM-W IM). The next PDSA cycle (See Figure 1) will use a newly implemented connection between EHRs to refer patients to adult care including KUSM-W IM to achieve a sustainable process and track all adult care referrals. The STARx will be replaced with a shorter questionnaire. Maintenance of certification credit will also be offered to KUSM-W Peds faculty.