A quality improvement evaluation of a standardized intervention for children with medical complexity transitioning to adult care

A quality improvement evaluation of a standardized intervention for children with medical complexity transitioning to adult care

Esser K; Adams S; Chung C; McKay T; Moore C; Wagman H; Lee S; Orkin J

Paediatrics and Child Health

2024

Article; Children with medical complexity; Family physicians; Health care transition; Multiple chronic conditions; Quality improvement; adolescent; adult; assisted ventilation; caregiver; checklist; child psychiatry; chronicity; conversation; decision support system; demographics; dietitian; disability; feedback system; general practitioner; health care access; health care personnel; health care utilization; hospital; human; information processing; major clinical study; medical record review; medical technology; multidisciplinary team; nurse practitioner; patient care; pediatric patient; pediatrician; pediatrics; pharmaceutical care; pharmacist; rehabilitation; school; social worker; standardization; total quality management; transition to adult care; vascular access

Children with medical complexity have medical fragility, chronic disease, technology dependence, and high healthcare use. Their transition to adult health care at age 18 involves medical and social elements and follows no standardized process. Our goal was to improve transition readiness in children with medical complexity using a transition intervention within a Complex Care program. All children with medical complexity aged 14 to 18 were included in this quality improvement (QI) project (n = 54). We conducted a pre- and post-intervention chart review to assess transition outcomes and implemented a transition intervention for 6 months, which included an age-stratified checklist, charting template, and transition rounds. Before the intervention, 72% of 17- to 18-year-old patients had documented transition discussions, which increased to 86%. Patients with a family physician increased as well (61% to 73% for 17- to 18-year-olds). Three transition education rounds were held. The intervention increased transition readiness, provided tools to facilitate transition, and created a forum for conversation. © 2024 The Author(s). Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved.

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