Start with Leadership Support
We presented our healthcare transition project at a division meeting, and many providers were hesitant to put in extra effort given multiple competing demands and uncertainty about whether we could really move the needle on improving transition.
Obtaining leadership support prior to implementation of a healthcare transition process or intervention is important for three reasons. First, a leader can communicate a clear long-term vision and motivate team members to actively engage in an emotionally charged, challenging topic.
Second, improving healthcare transition outcomes requires an integrated, multidisciplinary approach that may be resource intensive. A leader can advocate for adequate clinical, administrative and health information technology (IT) support required to build and sustain a transition process.
Third, poor healthcare transition outcomes are not unique to rheumatology. A leader can often coordinate initiatives at a higher level, between divisions and/or institutions, to increase awareness of your project and leverage existing resources and content expertise.
Additionally, aligning your healthcare transition priorities with existing institutional priorities, such as decreasing hospital readmissions or improving patient safety, can be an effective way to garner leadership support.
A recent study among publicly insured & uninsured AYAs with chronic rheumatic disease reports an average gap of 221 days between the last pediatric visit & the first adult visit.
Create a Transition Roadmap
My child’s doctor never mentioned transition until my son turned 19 and was told it was time for him to transfer to adult care. I felt completely caught off guard and abandoned.
Standardization and normalization of the transition from pediatric to adult care is an important first step for a healthcare team. Standardizing transition processes ensures all patients have access to transition preparation and support, reducing the number of patients who fall through the cracks at their time of transfer. Normalizing the transition process creates the expectation that transition is an expected developmental step for all AYA patients, which will help build trust and motivate them to engage in transition preparation.
The Six Core Elements of Health Care Transition plan is the gold standard for a structured approach to pediatric-to-adult transitional care.13 Establishing all six core elements, which range from consistent dissemination of a transition policy to confirming transfer completion, is still an aspirational goal for many rheumatology practices.
Achieving a quick win is important to inspire team engagement and morale. Creation and dissemination of a transition policy, which describes the practice’s approach to transition, privacy and consent issues, and timing of transfer, is often a great place to start.
The goal of a transition policy is to provide a guide for AYAs to follow through the developmental process of becoming independent in their healthcare. If possible, try to avoid inflexible transition policies with a strict age at which transfer should occur. Rather, providers should engage in shared decision making with patients to choose a transfer date at least 12 months in advance of the anticipated transition to allow for development of self-management skills, navigation of insurance barriers and identification of an adult rheumatology provider.
Additionally, transition policies should be introduced early, at age 12–14 years, to encourage gradual development of self-management skills and evolving parent-child roles.
Examples of transition policies can be found within the Six Core Elements of Health Care Transition Implementation Guide and the ACR website.13
