O3244: Improving Healthcare Transition for Young Adults with Special Healthcare Needs Within a Large Academic Medical Center

Purpose/Objectives: Define: Healthcare transition (HCT) is the process of transitioning from a pediatric to adult model of care. Young Adults with Special Health Care Needs (YASHCN) require greater care coordination/social work to bridge their care and are at greater risk for adverse outcomes with poorly facilitated transition as compared to their healthy peers. Presently, Children’s Dallas Office of Patient Transition is a centralized department with additional decentralized transition care services within subspecialty clinics. However, UT Southwestern does not have a counterpart to facilitate the receipt of transferring patients. Literature review and interviews with Children’s Dallas Office of Patient Transition staff helped identify additional key potential barriers to successful HCTs.

Design/Methods: Measure: To better understand accepting physician-perceived barriers to HCT and better inform potential HCT clinic services, faculty representatives from the Internal Medicine divisions, Neurology, Psychiatry, Physical Medicine and Rehabilitation, and Urology departments (N=15) participated in a virtual interview process as part of the “measure” phase. The interview survey script included Likert-scale and open-ended questions regarding system-wide barriers to HCT. Additional thematic analysis was used to identify common themes and barriers to the successful transfer and integration of care of YASHCN.

Results: Analyze: Physicians identified primary care access (n=11), specialty care coordination (n=9), insufficient care coordination support (n=13) and lack of training exposure as system-wide barriers (n=11) to HCT. Interestingly, physicians with higher care coordination support (i.e. Division of Cardiology) did not endorse the same perceived barriers, further suggesting the benefit of a multidisciplinary transition clinic. Physicians listed support staff, warm hands-offs, and patient education as potential improvements. These findings helped inform areas of improvement and the development of change ideas (Figure 1 Driver Diagram).

Conclusion/Discussion:

Design: These initial findings highlight the need to develop innovative solutions to address existing barriers in HCT for YASCHN within our large academic health system. To address this gap, the Division of Combined Internal Medicine and Pediatrics aims to establish consultative clinic model, which will include a multidisciplinary team clinic and a transition task force to prepare patients/families for HCTs (Figure 2 Process Map).

Validate: Next steps include clinic implementation and validation, in which predefined process outcome, process, and balancing measures will track the HCT clinic performance to improve the transfer and integration of care for this vulnerable patient population and support the healthcare professionals who care for them.