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Improving Transition of Care for Pediatric Patients With Chronic Kidney Disease: A Pilot Project
Melvin Chan1, Sarah Young2, Melisha Hanna1
1Pediatric Nephrology, Children's Hospital Colorado, Aurora, USA.
Insights
Younger age and male gender predict poor transition readiness in pediatric chronic kidney disease (CKD) patients. A structured remote curriculum significantly improved transition readiness across all domains.
Area of Science:
- Pediatric Nephrology
- Transition of Care
- Chronic Kidney Disease Management
Background:
- Transitioning pediatric patients to adult care is crucial for long-term health outcomes.
- Poor transition from pediatric to adult healthcare systems is associated with increased healthcare utilization and worse kidney outcomes.
- Limited research exists on predictors of transition readiness and effective interventions for pediatric patients with chronic kidney disease (CKD).
Purpose of the Study:
- To identify predictors of transition readiness in adolescents and young adults with CKD.
- To evaluate the effectiveness of a structured, remote curriculum in improving transition readiness.
- To assess the impact of age and gender on transition readiness in this population.
Main Methods:
- Enrolled 42 non-dialysis, non-transplant CKD patients (stage 2+, aged 14+).
- Collected demographic and clinical data, assessing transition readiness using the Transition Readiness Assessment Questionnaire (TRAQ).
- Implemented a structured, remote curriculum and administered repeat TRAQ assessments after six months.
Main Results:
- Younger age and male gender were identified as risk factors for poor transition readiness.
- Older age positively correlated with higher TRAQ scores in medication, appointment, and total domains.
- Male gender was associated with lower TRAQ scores in appointment and communication domains.
- The curriculum improved TRAQ scores by approximately 25% across all domains within six months.
- Follow-up interval (3 vs. 6 months) did not significantly impact outcomes.
Conclusions:
- Younger age and male gender are significant risk factors for inadequate transition readiness in pediatric CKD.
- A structured, remote educational curriculum effectively enhances transition readiness in this patient group.
- These findings highlight the need for targeted interventions to support vulnerable patient subgroups during care transitions.
Abstract:
Introduction Transition is the process of preparing an adolescent or young adult for the adult model of care. Poor transitions have been linked to increased medical utilization and poorer kidney outcomes. There are limited studies evaluating predictors of transition readiness or interventions in pediatric patients with chronic kidney disease (CKD). Methods We enrolled 42 non-dialysis, non-transplant patients with CKD stage 2 or higher and 14 years and older receiving care in our pediatric nephrology clinic. Data collected included demographics, clinical information, and transition readiness as measured by the Transition Readiness Assessment Questionnaire (TRAQ). Patients were provided with a structured, remote curriculum with resources that addressed areas of need. Patients were followed every three to six months. Repeat TRAQ questionnaires were administered six months after enrollment. Results Our study found that younger age and male gender were risk factors for poor transition. Age was consistently a positive predictor of higher TRAQ scores in the medication, appointment, and total score domains (p < 0.05). Male gender was a risk factor for lower TRAQ scores in the appointment and communication domains (p < 0.05). Additionally, our curriculum was effective at improving scores across all TRAQ domains, with an average increase of about 25% in six months. There was no difference in patients who had a three-month follow-up as compared to a six-month follow-up (p > 0.05). Conclusion Our study finds that younger age and male gender are risk factors for poor transition. Additionally, a structured, remote curriculum is effective at improving transition readiness.
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