Creating a sustainable pediatric diabetes transition program

A health care transition focused quality improvement project was implemented in a large urban pediatric endocrinology clinic to evaluate the effectiveness of the administration of the Transition Readiness Assessment Questionnaire (TRAQ) by identifying barriers to implementation and creating a more sustainable format.

A pre- and post-intervention evaluation design was used in this quality improvement project. A twelve-month chart review of pediatric endocrine clinic patients diagnosed with diabetes who were 14 years of age or older and met eligibility criteria was conducted. Patients given the TRAQ tool were identified and assessed for documentation of goals and goal achievement. Discussions regarding the implementation of the TRAQ tool were conducted with clinic staff to identify process barriers and develop solutions. A post-implementation twelve-month review was conducted to evaluate for improved documentation and achievement of transition focused goals.

Several barriers were identified that minimized the effectiveness of the TRAQ tool including lack of staff trained to assist with insulin pump and meter downloads and proximity of diabetes software. Additional staff were trained, and software was relocated to a more centrally located area with greater staff accessibility to allow for discussion of transition goals with patient and family. The new process resulted in a 100% increase in documentation of transition goals and met goals (p ≤0.001).

The TRAQ tool is valuable for directing transition needs if implementation barriers such as staff training and accessibility to software are monitored and addressed. Frequent evaluation of the administration of the TRAQ tool protocol in the clinic setting is recommended in order to support pediatric patients' successful transition to adult care.