P3.N275: Transitioning Young Adults to Adult Primary Care Quality Improvement Initiative

Purpose/Objectives: Young adult patients often face challenges accessing care after transitioning out of pediatric primary care. Pediatric primary care providers often cite difficulty identifying adult primary care providers for their young adult patients. Prior quality improvement research through our program identified that Internal Medicine-Pediatric (Med-Peds) residents and faculty feel more prepared to care for young adults and fill this role. This project aimed to enhance access to adult primary care providers for young adults between the ages of 18-30 years old.

Design/Methods: One internal medicine primary care clinic, staffed in part by Med-Peds trainees, was chosen for this study. Target patients included new patients between 18-30 years of age. Baseline data from July 2021 – June 2022 was collected to evaluate the number, demographics, and burden of chronic medical conditions of target patients seen per eligible Med-Peds residents. Fourth year residents were excluded since they do not accept new patients. In the initial Plan-Do-Study-Act cycle, a new appointment template was created, and two appointment slots were held per week per Med-Peds resident for target patients. Cycle 1 occurred from March 2023 – June 2023.

Results: At baseline, Med-Peds residents saw 0.58 new patients 18-30 years each quarter of a year. During Cycle 1, Med-Peds residents saw 2.6 target patients per quarter. This represented an over 300% increase in new patients 18-30 years seen by Med-Peds residents. Of patients characterized in the baseline data, 60.7% identified as female. In Cycle 1, 51.4% identified as female and 8.1% identified as non-binary. About 86% of patients in our baseline data had 1 or more chronic medical condition, compared to about 78% of patients in Cycle 1.

Conclusion/Discussion: The initial PDSA cycle suggests that adding reserved new patient visit slots for young adult patients is an effective method to increase the number of young adult new patients seen by Med-Peds residents. Subsequent cycles will attempt to disseminate referral process to pediatric primary care clinics and address additional barriers to accessing these appointments for young adult patients, further focusing on patients with one or more chronic medical problems, intellectual disabilities, or social barriers to transition of care.