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A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes

BACKGROUND: The transition of health care from Pediatric to Adult providers for adolescents and young adults with chronic disease is associated with poor outcomes. Despite the importance of this transition, over 80% of these patients do not receive the services necessary to transition to Adult healt...

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Autores principales: Overbury, Rebecca S., Huynh, Kelly, Bohnsack, John, Frech, Tracy, Hersh, Aimee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8638174/
https://www.ncbi.nlm.nih.gov/pubmed/34852832
http://dx.doi.org/10.1186/s12969-021-00651-w
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author Overbury, Rebecca S.
Huynh, Kelly
Bohnsack, John
Frech, Tracy
Hersh, Aimee
author_facet Overbury, Rebecca S.
Huynh, Kelly
Bohnsack, John
Frech, Tracy
Hersh, Aimee
author_sort Overbury, Rebecca S.
collection PubMed
description BACKGROUND: The transition of health care from Pediatric to Adult providers for adolescents and young adults with chronic disease is associated with poor outcomes. Despite the importance of this transition, over 80% of these patients do not receive the services necessary to transition to Adult health care. In 2018, we initiated a transition clinic structure, integrating an Internal Medicine - Pediatrics trained Adult Rheumatologist in a Pediatric Rheumatology clinic to guide this transition. Our goal was to improve transition outcomes. We report the methods of this clinic and its preliminary outcomes. METHODS: For patients referred to the transition clinic, the Adult Rheumatologist assumed medical management and implemented a six-part modular transition curriculum. This curriculum included a Transition Policy, Transition Readiness Assessment, medication review and education, diagnosis review and education, and counseling on differences between Pediatric and Adult-oriented care. Eligible patients and their families were enrolled in a prospective observational outcomes research registry. Initial data from this transition clinic is reported including adherence with certain aspects of the transition curriculum and clinic utilization. RESULTS: The transition clinic Adult Rheumatologist saw 177 patients in 2 years, and 57 patients were eligible for, approached, and successfully enrolled in the registry. From this registry, all patients reviewed the Transition Policy with the Adult Rheumatologist and 45 (78.9%) completed at least one Transition Readiness Assessment. Of the 22 patients for whom transition was indicated, all were successfully transitioned to an Adult Rheumatologist. 17 (77.3%) continued care post-transition with the transition clinic Adult Rheumatologist, and 5 (22.7%) continued care post-transition with a different Adult Rheumatologist. The median time between the last transition clinic visit and first Adult clinic visit was 5.1 months. CONCLUSIONS: Our experience demonstrated the success of our clinic model regarding participation in the transition curriculum and improved clinic utilization data. Our results are an improvement over transition rates reported elsewhere that did not implement our model. We believe that this structure could be applied to other primary care and subspecialty clinics. TRIAL REGISTRATION: This research was approved by the University of Utah Institutional Review Board (IRB) in January 2019 (IRB_00115964). Patients were retrospectively registered if involved prior to this date. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12969-021-00651-w.
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spelling pubmed-86381742021-12-02 A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes Overbury, Rebecca S. Huynh, Kelly Bohnsack, John Frech, Tracy Hersh, Aimee Pediatr Rheumatol Online J Research Article BACKGROUND: The transition of health care from Pediatric to Adult providers for adolescents and young adults with chronic disease is associated with poor outcomes. Despite the importance of this transition, over 80% of these patients do not receive the services necessary to transition to Adult health care. In 2018, we initiated a transition clinic structure, integrating an Internal Medicine - Pediatrics trained Adult Rheumatologist in a Pediatric Rheumatology clinic to guide this transition. Our goal was to improve transition outcomes. We report the methods of this clinic and its preliminary outcomes. METHODS: For patients referred to the transition clinic, the Adult Rheumatologist assumed medical management and implemented a six-part modular transition curriculum. This curriculum included a Transition Policy, Transition Readiness Assessment, medication review and education, diagnosis review and education, and counseling on differences between Pediatric and Adult-oriented care. Eligible patients and their families were enrolled in a prospective observational outcomes research registry. Initial data from this transition clinic is reported including adherence with certain aspects of the transition curriculum and clinic utilization. RESULTS: The transition clinic Adult Rheumatologist saw 177 patients in 2 years, and 57 patients were eligible for, approached, and successfully enrolled in the registry. From this registry, all patients reviewed the Transition Policy with the Adult Rheumatologist and 45 (78.9%) completed at least one Transition Readiness Assessment. Of the 22 patients for whom transition was indicated, all were successfully transitioned to an Adult Rheumatologist. 17 (77.3%) continued care post-transition with the transition clinic Adult Rheumatologist, and 5 (22.7%) continued care post-transition with a different Adult Rheumatologist. The median time between the last transition clinic visit and first Adult clinic visit was 5.1 months. CONCLUSIONS: Our experience demonstrated the success of our clinic model regarding participation in the transition curriculum and improved clinic utilization data. Our results are an improvement over transition rates reported elsewhere that did not implement our model. We believe that this structure could be applied to other primary care and subspecialty clinics. TRIAL REGISTRATION: This research was approved by the University of Utah Institutional Review Board (IRB) in January 2019 (IRB_00115964). Patients were retrospectively registered if involved prior to this date. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12969-021-00651-w. BioMed Central 2021-12-01 /pmc/articles/PMC8638174/ /pubmed/34852832 http://dx.doi.org/10.1186/s12969-021-00651-w Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Overbury, Rebecca S.
Huynh, Kelly
Bohnsack, John
Frech, Tracy
Hersh, Aimee
A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes
title A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes
title_full A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes
title_fullStr A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes
title_full_unstemmed A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes
title_short A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes
title_sort novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8638174/
https://www.ncbi.nlm.nih.gov/pubmed/34852832
http://dx.doi.org/10.1186/s12969-021-00651-w
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