(243) Revamping the transition to adult care process in a pediatric center: Implementation of a one-on-one meeting process

Background: Most teens with special health care needs (SHCN) and their families do not receive adequate support in the transition from pediatric to adult health care. The 2016 National Survey of Children’s Health indicated that 83% of teens with SHCN did not meet the national health care transition performance measure standards, including time to speak alone with their healthcare providers [1]. Meeting one-on-one (1:1) with providers can help establish this practice as part of routine care and allows for regular opportunities to discuss concerns in an open manner [2]. However, studies have shown that as little as 38% of teens between the ages of 15-17 have met alone with a provider during routine clinic visits [3]. The current quality improvement project seeks to implement systematic 1:1 visits as part of the pediatric clinic’s transition to adult care process. We aimed to have 60% of eligible teens provided education on the 1:1 process and have a 1:1 visit with a provider by the end of 2021.

Methods: A transition registry was created and maintained for all Cystic Fibrosis teens ages ≥ 17 years old beginning the transition process. Teens ages 17-22 participated in our clinic’s transition process between January 1, 2021, through December 31, 2021. Eligible teens were identified during weekly patient review by the psychosocial team and clinical educator for 1:1 visits. Teens were educated on 1:1 visits using materials adapted from GOT Transition and CDC Guidelines (Figure 1). Teens with 1:1 visits were indicated on the CF clinic track board and marked on their patient visit sheet for provider identification. Survey data was collected electronically at the end of the visit from May through December 2021. Surveys sought to understand the feasibility and acceptability of 1:1 visit by providers and teens. Surveys were discontinued when data saturation was reached.

Results: Forty-nine teens, ages 17-22, were eligible to participate in the 1:1 transition process, 67% of those teens received 1:1 education, 57% met one-on-one with a provider. Of those eligible, 3 teens refused to meet 1:1. We did meet our goal of educating 60% but did not meet our goal in 60% of the teens meeting 1:1 within the 2021 year. Twenty-two teens who participated in 1:1 visits in 2021 were surveyed. 100% of teens and providers found the 1:1 visits helpful and productive. 96% of teens felt comfortable meeting alone with providers.

Conclusions: 1:1 visits are a useful tool in preparing teens and young adults for transition to adult care. Both providers and teens expressed favorability for 1:1 visits and were able to discuss important health related concerns collaboratively. Barriers to the 1:1 visits included parent or teen refusal, missed appointments, as well as family preference for inclusion of parents during visits addressing admissions or pulmonary exacerbations. Our next steps include participation of 1:1 visits with ancillary team members such as social work, psychology, and nursing.

Acknowledgements:

References: [1] Lebrun-Harris LA, McManus MA, Ilango SM, Cyr M, McLellan SB, Mann MY, et al. Transition planning among US youth with and without special health care needs. Pediatrics. 2018;142(4).

[2] Ford C, English A, Sigman G. Confidential Health Care for Adolescents: position paper for the society for adolescent medicine. J Adolesc Health. 2004;35(2):160-7.

[3] Copen CE, Dittus PJ, Leichliter JS. Confidentiality concerns and sexual and reproductive health care among adolescents and young adults aged 15-25. NCHS Data Brief. 2016;(266):1-8