1. Transition Project and Grant
Vignesh Doraiswamy, Michael McCann,
Jaime Moellman, David Shore,
Diana Spell, Aaron Tober

2. Objectives Introduction to Transition Education for residents
Medicine and Pediatrics
Research goals
Current expectations
Future projects

3. Introduction
“The purposeful, planned, movement of adolescents and young adults with chronic physical and medical conditions from child-centered care to the adult- oriented health care system”
Goal: Successful management of chronic medical conditions

4. Quick stats
6 million children with developmental delay or mental health disability
10.2 million children with chronic medical problem
40% of all health care costs for all children and adolescents
500,000 of patients with special needs who will reach 21 years
Affects: quality of life, access to medical care, disease outcomes, future education, and employment

5. Clinical vignettes Earvin Christine 12 year old boy 17 year old girl
Poorly controlled asthma
Autism spectrum disease
Sickle cell disease
Spina bifida, wheelchair dependent.
Frequent hospitalizations
Requires self catheterization; history of frequent UTI’s
Currently in the 7th grade
Special education
Functioning at 6th grade level
Functioning at 8th grade level; able to do ADLs
Seen monthly in heme/onc clinic

6. Initiation
Collaboration between adolescents/young adults, parents, and health care clinicians
Multifactorial aspects to success
Family, individual, environmental, health systems
Barriers:
May be difficult for patients/families to trust new adult provider
Expectations for patients to have autonomy- parents may not always be welcome
Patients and families need to be adequately prepared
Increased complications, missed medical appointments therefore poorer outcomes

7. Preparation Starting age: 12 years old (varies) Discussion: Timeline
Introduction and assessment
Purpose, rationale, importance of transition
Timeline
Following/monitoring
Older kids with intellectual disabilities- need to discuss conservatorship

8. TRAQ Forms:

10. Follow up
Earvin and Christine

13. Phases of Transition Phase I: Ages 12-14 Educate about Transition
Introduce Transition Office Policy
Phase II: Ages 15-18
Portable Health Care Summary
Barriers to Transition
Phase III: Ages 18-25
Adult Health Care Model and Translate Care to Adult Provider
Why Adult Providers specializing in complications of pediatric disease

14. Presentations for IM Residents
Important Principles in Management
Weight-based dosing
Psycho-social component of care
Pediatric Neurology Conditions
Cerebral Palsy
Seizure disorders
Musculoskeletal disorders
Pediatric Cardiology Conditions
Congenital heart disorders

15. Clinic Survey IRB needs to be obtained Goal: n=100
Assess patient and parent’s understanding of transitional medicine
Provide intervention in clinic
Re-assess
3rd Street Clinic will be trial run, then expand to other Pediatric clinics

16. Sample Survey Have you heard of Transitional Medicine before?
If yes, from what source?
Possible follow up multiple choice selection with definition
Has your doctor spoken to you about Transitional Medicine?
Would you like to learn more about transitional medicine?
Patient identifiers (age group, name, MRN)

17. Project Aims
Disseminate and educate the concept of transition to patients and their families
Test the effectiveness of patient-facing informational material in teaching medical concepts.

18. Methods
• Study design: Prospective before – and – after design, where our intervention will be the introduction of educational materials to the clinic. • Inclusion criteria: Male and female patients, age between 12 and 22 • Exclusion criteria: Age above 22, or below 12. Non-English, Non-Spanish speaking patients. Patients unable to read English or Spanish • Intervention: Creation and dissemination of educational materials via posters and pamphlets. • Goal enrollment – 100 patients, 50 control and 50 experimental cohort • Control group: All adolescent patients that present to clinic during the first 5 months of the trial, before the dissemination of educational materials. • Experimental group: All adolescent patients that present to the clinic in the latter 5 month period after the dissemination of educational materials.

19. Evaluation Plan
Primary endpoints : 1) Knowledge and awareness of transition of care as evaluated by questionnaire. 2) Ability and readiness to transition as evaluated by questionnaire Secondary Endpoints: Providers ability to teach and coordinate transition of care, as evaluated by questionnaire Evaluation: We will create a brief survey to evaluate our patients awareness and understanding of what transition is We will use a modified form of the Transition Readiness Form to assess our patients’ readiness for transition. This questionnaire asks specific questions identifying patients medical needs, and their awareness, understanding, and questions about their own medical needs, and how they would use that information as a young adult. We will create a brief survey, to be given to our providers (residents and attendings) twice, once at the end of the first 5 months, and later at the last 5 months, to gauge their comfort and ability to teach patients about transition. Statistical analysis will occur at the end of 5 months to determine our patients baseline understanding of and ability to transition, and at the end of 10 months to assess how our intervention has impacted these domains.

20. Expectations Continue to complete TRAQ forms
Portable health care summary
Summaries on smart phones
Research implications

21. Future Social worker who assists with transition
If all goes well in our clinic, would like to expand to gen peds and other subspecialty pediatric clinics
Grand Rounds
Med Peds consult service

22. References:
Got Transition?
Pediatrics in Review

23. THANK YOU!

24. Update on Med-Peds Elective