Pediatric to adult primary care transition for medically complex youth: A tale of learning from challenges experienced implementing a pilot project during COVID-19
Purpose: The aim of our article is to describe our learning based on challenges encountered implementing two related pediatric to adult primary care transition pilots for medically complex adolescents and young adults as part of the Children with Medical Complexity Collaborative for Improvement and...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | Health Care Transitions |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949923223000272 |
| _version_ | 1797235376107028480 |
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| author | Reem Hasan Reyna Lindert Danielle Sullivan Shreya Roy Alison J. Martin |
| author_facet | Reem Hasan Reyna Lindert Danielle Sullivan Shreya Roy Alison J. Martin |
| author_sort | Reem Hasan |
| collection | DOAJ |
| description | Purpose: The aim of our article is to describe our learning based on challenges encountered implementing two related pediatric to adult primary care transition pilots for medically complex adolescents and young adults as part of the Children with Medical Complexity Collaborative for Improvement and Innovation Network. Design: We undertook two sequential pilot projects. The first focused on supporting the transfer stage for an older group of medically complex young adults to facilitate their establishment with an adult primary care provider. Based on our learning from barriers encountered, and setting constraints due to COVID-19, we developed and implemented a second project to engage pediatric primary care providers in initiating and documenting transition preparation discussions for a younger group of medically complex youth. A multi-disciplinary Implementation Team guided each phase’s implementation. Results: We did not achieve our objective in the first pilot, partly due to provider reluctance. Providers perceived the patient was not ready, reported that the patient was experiencing active health problems, or wanted to keep the patient on their panel. We partially achieved the second pilot’s objective; three-quarters of identified patients completed their appointments, and electronic health record documentation suggests that providers initiated transition discussions with more than half of those patients. Conclusions: Pediatric primary care has an important role in supporting health care transition for medically complex youth. Our findings suggest that pediatric primary care providers require time, connection to adult PCPs, and educational support to realize this role. Practice implications: To provide comprehensive transition services for medically complex patients, pediatric primary care will need to develop relationships with adult primary care providers, make available training about transition preparation for its providers, and support patients and families in locating adult primary care providers who are accepting new patients. |
| first_indexed | 2024-04-24T16:46:58Z |
| format | Article |
| id | doaj.art-1339350ee0834830ab7bd1361f2b5aea |
| institution | Directory Open Access Journal |
| issn | 2949-9232 |
| language | English |
| last_indexed | 2024-04-24T16:46:58Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Health Care Transitions |
| spelling | doaj.art-1339350ee0834830ab7bd1361f2b5aea2024-03-29T05:52:41ZengElsevierHealth Care Transitions2949-92322023-01-011100027Pediatric to adult primary care transition for medically complex youth: A tale of learning from challenges experienced implementing a pilot project during COVID-19Reem Hasan0Reyna Lindert1Danielle Sullivan2Shreya Roy3Alison J. Martin4Department of Pediatrics, Oregon Health & Science University, Portland, OR, United States; Department of Internal Medicine, Oregon Health & Science University, Portland, OR, United States; Correspondence to: Department of Internal Medicine and Pediatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States.Office of Primary Care & Population Health, Oregon Health & Science University, Portland, OR, United StatesDepartment of Pediatrics, Oregon Health & Science University, Portland, OR, United StatesOregon Center for Children and Youth with Special Health Needs, Institute on Development and Disability, Oregon Health & Science University, Portland, OR, United StatesOregon Center for Children and Youth with Special Health Needs, Institute on Development and Disability, Oregon Health & Science University, Portland, OR, United States; Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, United StatesPurpose: The aim of our article is to describe our learning based on challenges encountered implementing two related pediatric to adult primary care transition pilots for medically complex adolescents and young adults as part of the Children with Medical Complexity Collaborative for Improvement and Innovation Network. Design: We undertook two sequential pilot projects. The first focused on supporting the transfer stage for an older group of medically complex young adults to facilitate their establishment with an adult primary care provider. Based on our learning from barriers encountered, and setting constraints due to COVID-19, we developed and implemented a second project to engage pediatric primary care providers in initiating and documenting transition preparation discussions for a younger group of medically complex youth. A multi-disciplinary Implementation Team guided each phase’s implementation. Results: We did not achieve our objective in the first pilot, partly due to provider reluctance. Providers perceived the patient was not ready, reported that the patient was experiencing active health problems, or wanted to keep the patient on their panel. We partially achieved the second pilot’s objective; three-quarters of identified patients completed their appointments, and electronic health record documentation suggests that providers initiated transition discussions with more than half of those patients. Conclusions: Pediatric primary care has an important role in supporting health care transition for medically complex youth. Our findings suggest that pediatric primary care providers require time, connection to adult PCPs, and educational support to realize this role. Practice implications: To provide comprehensive transition services for medically complex patients, pediatric primary care will need to develop relationships with adult primary care providers, make available training about transition preparation for its providers, and support patients and families in locating adult primary care providers who are accepting new patients.http://www.sciencedirect.com/science/article/pii/S2949923223000272Primary careMedically complexPediatric to adult transitionBarriersHealth care transitionChildren with medical complexity |
| spellingShingle | Reem Hasan Reyna Lindert Danielle Sullivan Shreya Roy Alison J. Martin Pediatric to adult primary care transition for medically complex youth: A tale of learning from challenges experienced implementing a pilot project during COVID-19 Health Care Transitions Primary care Medically complex Pediatric to adult transition Barriers Health care transition Children with medical complexity |
| title | Pediatric to adult primary care transition for medically complex youth: A tale of learning from challenges experienced implementing a pilot project during COVID-19 |
| title_full | Pediatric to adult primary care transition for medically complex youth: A tale of learning from challenges experienced implementing a pilot project during COVID-19 |
| title_fullStr | Pediatric to adult primary care transition for medically complex youth: A tale of learning from challenges experienced implementing a pilot project during COVID-19 |
| title_full_unstemmed | Pediatric to adult primary care transition for medically complex youth: A tale of learning from challenges experienced implementing a pilot project during COVID-19 |
| title_short | Pediatric to adult primary care transition for medically complex youth: A tale of learning from challenges experienced implementing a pilot project during COVID-19 |
| title_sort | pediatric to adult primary care transition for medically complex youth a tale of learning from challenges experienced implementing a pilot project during covid 19 |
| topic | Primary care Medically complex Pediatric to adult transition Barriers Health care transition Children with medical complexity |
| url | http://www.sciencedirect.com/science/article/pii/S2949923223000272 |
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