Improving Adolescent and Young Adult Engagement in the Process of Transitioning to Adult Care.

PURPOSE: Health care transition (HCT) is the complex process of changing from pediatric to adult-centered care. Comprehensive HCT processes have been associated with improved outcomes in all elements of the Triple Aim. Nationally accepted best practices emphasize Six Core Elements of HCT, including the use of transition readiness assessment tools completed during clinic visits. Specifically, Got Transition's tools include two 0-10 point self-report scales on the validated domains of importance of changing to an adult provider and managing their healthcare, and confidence in their ability to transition. The aim of this quality improvement project (QIP) was to improve the engagement of adolescents and young adults (AYAs), aged 14-20, in the process of transitioning from pediatric to adult care. The sub-aim focused specifically on parent/caregiver engagement in transition, using the same scales in a tool for parents/caregivers. An urban federally qualified health center initiated this QIP. METHODS: This QIP utilized the Institute for Healthcare Improvement Model for Improvement and plan-do-study-act cycles. RESULTS: Eighty-five AYAs and 40 parents/caregivers completed readiness assessments twice. Scores improved overall, reaching statistical significance with a small change in AYA mean scores for importance (.94) and confidence (.75). Provision of a transition policy and completion of readiness assessments by AYAs and parents/caregivers met the 70% goal. Patient portal enrollments increased from 4.2% to 12.5%, although did not meet the 30% goal. CONCLUSIONS: Engagement of AYAs and parents/caregivers was improved as a result of this QIP. Successful routine implementation of transition process measures demonstrated improved clinic-wide communication.

Pediatric Nurse Practitioners' Perspectives on Engaging Adolescents to Shift from Pediatric to Adolescent-Focused Health Care Services.

INTRODUCTION: This study examined the perspectives of pediatric nurse practitioners (PNPs) on the shift from pediatric to adolescent-focused health care services (HCS). This movement coincides with the early stages of the health care transition process. METHOD: Conference attendees (N = 170) participated in a discussion on the shift from pediatric to adolescent-focused HCS. A secondary analysis was conducted. Data were analyzed for themes using content analysis. RESULTS: Confidentiality was found to be a foundational aspect of adolescent-focused HCS. Two additional themes described adolescent-focused HCS characteristics and the role of the PNP in providing education and empowerment for adolescents and parents throughout this process. DISCUSSION: PNPs provide critical leadership in facilitating the shift to adolescent-focused care by providing HCS designed to support confidentiality, respond to the needs of adolescents, and offer education to empower adolescents and parents on the importance of adolescent-focused care and engagement in the overall health care transition process.

Evaluation of a Health Care Transition Improvement Process in Seven Large Health Care Systems.

PURPOSE: Youth and young adults require systematic planning, transfer and integration into adult healthcare. A national health care transition (HCT) learning network (LN) shared strategies during monthly calls to improve HCTs using Got Transition™'s Six Core Elements. Among LN participants, we conducted a pre-post mixed-methods evaluation of this evidence-informed process improvement framework. DESIGN AND METHODS: Leaders from seven health systems in the LN recruited 55 participating practice sites (12 primary care, 43 specialty care, 47 pediatric care, and 8 adult care). Got Transition's Current Assessment (CA) of HCT Activities (possible score: 0-32) assessed implementation of HCT process improvements in all 55 sites at baseline (2015-2017) and again after 12-18 months. Pre-post results were compared overall and by type of practice (primary vs. specialty, pediatric vs. adult). In early 2018, health system leaders qualitatively described factors impacting HCT process implementation. RESULTS: Overall, baseline CA scores averaged 10.7, and increased to 17.9 after 12-18 months. Within each clinical setting, scores increased from: 10.8 to 16.5 among 12 primary care sites, 12.8 to 17.1 among 43 specialty sites, 12.4 to 17 among 47 pediatric sites, and 12 to 16.9 among 8 adult sites. All changes reached significance (p < 0.05). Qualitative feedback offered valuable feedback about motivators, facilitators and barriers to HCT process improvement. CONCLUSIONS: Participating systems made substantial progress in implementing a structured HCT process consistent with clinical recommendations using the Six Core Elements. PRACTICE IMPLICATIONS: The diverse perspectives of participating health systems provide a model for creating sustainable HCT process improvements.

Pediatric Nurse Practitioners' Perspectives on Health Care Transition From Pediatric to Adult Care.

INTRODUCTION: This study examined the perspectives of pediatric nurse practitioners (PNPs) regarding the needs of adolescents, parents/caregivers, clinicians, and institutions in the health care transition (HCT) process for adolescents/young adults. METHODS: PNPs (N = 170) participated in a luncheon for those interested in transition at an annual conference. Small groups discussed and recorded their perspectives related to health care transition from adolescent to adult services. Content analysis was used to analyze responses (Krippendorff, 2013). RESULTS: Four themes, Education, Health care system, Support, and Communication, emerged from the data analysis. PNPs identified health care informatics and adolescents' use of technology as additional critical aspects to be considered in health care transition. DISCUSSION: Opportunities and challenges identified by the PNPs are discussed to improve the quality and process of transitioning adolescents to adult services. This report will help National Association of Pediatric Nurse Practitioners formulate a new Health Care Transition Policy Statement for the organization.

Anaphylaxis from depot medroxyprogesterone acetate in an adolescent girl.

BACKGROUND: Anaphylaxis postinjection of depot medroxyprogesterone acetate (DMPA) has been rarely reported in adult women. CASE: A 16-year-old girl developed anaphylaxis after receiving 150 mg of DMPA intramuscularly. She previously had received four injections of DMPA without any adverse reactions, including two earlier doses from the same lot number. She initially was treated in the clinic and was stabilized in the emergency department, with full recovery. She subsequently underwent allergy testing, which was inconclusive, and decided to use the copper intrauterine device for ongoing contraception. CONCLUSION: Anaphylaxis, a rare complication of DMPA, can occur even if a patient had no adverse reactions from previous injections from the same lot number.