P3.N270: Provider Knowledge and Perceptions of Transitions from Pediatric to Adult Inpatient Services

Background: The majority of adolescents with complex medical needs are surviving into adulthood with higher rates of healthcare utilization and hospitalizations during the transition from pediatric to adult care. Resources and tools have been developed to prepare for this transition within the outpatient setting, but little is known about provider transition training in the inpatient setting. Our study aims to evaluate providers’ perspectives regarding current inpatient transition practices.

Methods: From October 2023 to November 2023, six semi-structured focus groups were conducted via Zoom video conferencing with providers in pediatrics, internal medicine, internal medicine-pediatrics and family medicine at an academic, quaternary health system. Approval was obtained by the local IRB. Two interviewers led the participants' discussion through five pre-determined domains inspired by Got Transition’s Six Core Elements of Health Care Transition. These domains included experiences with transition, transition readiness, transition planning, accessibility of the adult system, and transition completion. The interview transcript was coded and analyzed using Dedoose software. The coding scheme followed the interview guide outline and conclusions were made based on overall themes of the codes.

Results: Thirteen providers participated in the study. Negative inpatient transition experiences were discussed in all focus groups and represented 45% of all inpatient transition experiences. Forty-four challenges with inpatient transitions were organically elicited. The most common challenges were lack of provider knowledge on transition policies (23%), discordance between pediatric and adult providers (16%), adult provider inexperience with congenital conditions (14%), and fragmented care (11%, Table 1). Various themes regarding current inpatient transition practices were also derived from the responses (Figure 1). Commonly identified factors associated with timing of adolescent involvement in medical decision-making were the adolescent’s medical complexity (23%) and developmental stage (16%), followed by age (13%), maturity (13%), and parental preference (13%). Factors determining timing of transition to the adult hospital were similarly variable with age (18%), medical complexity (18%), and maturity (23%) being reported. Providers’ most frequent expectations regarding inpatient transitions were inter-provider communication (52%) and patient and caregiver education (24%). The need for multi-disciplinary transition support was also repeatedly emphasized. When asked to suggest potential solutions for current inpatient transition shortcomings, providers discussed improved patient resources in 67% of focus groups, designated transition coordinators in 50%, and patient summaries in 33%.

Conclusion: Providers at a single center interacting with adolescents during various stages of the transition process report multiple challenges in effectively transitioning adolescent patients from the pediatric to adult hospital. Providers cited that a lack of knowledge surrounding transition policies is the largest barrier, which may contribute to provider variability in responses on transition readiness. Efforts should be made to develop inpatient transition programs with interdisciplinary involvement and improved provider and patient education regarding transitions.