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Pediatric to Adult Care Transition in the Hospital Context (PATCH) Tool: A Novel Tool to Assess Pediatric
Ann-Marie Tantoco1, Rachel Peterson2, Bethany Corbin3
1Department of Medicine (A-M Tantoco), Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics (A-M Tantoco), Northwestern University Feinberg School of Medicine, Chicago, Ill.
Insights
A new tool, the Pediatric to Adult Transitional Care in the Hospital Context (PATCH) tool, was developed to help pediatric institutions improve health care transition (HCT) for adults with childhood onset chronic conditions (COCC).
Area of Science:
- Pediatric healthcare
- Chronic condition management
- Healthcare transition
Background:
- Increasing numbers of adults with childhood onset chronic conditions (COCC) are admitted to pediatric institutions.
- Pediatric institutions lack specific guidance on incorporating health care transition (HCT) policies into inpatient care.
- A need exists for tools to assess and improve inpatient HCT for adults with COCC.
Purpose of the Study:
- To develop a framework-based tool, the Pediatric to Adult Transitional Care in the Hospital Context (PATCH) tool.
- To assess how pediatric institutional guidelines address inpatient care for adults with COCC.
- To inform future development of PATCH guidelines for improved HCT.
Main Methods:
- 11 pediatric institutional guidelines were collected using convenience and snowball sampling.
- The PATCH tool was developed by combining existing models and iterative consensus building.
- Interrater reliability and content validity were assessed using established methods.
Main Results:
- The finalized PATCH tool comprises 42 items across nine domains.
- High interrater agreement and no missing items were identified through qualitative analysis.
- 59% of PATCH tool items were found in existing guidelines, with age being universally addressed.
Conclusions:
- The PATCH tool provides a guide for pediatric institutions caring for adolescent and adult patients.
- Integrating the PATCH tool into practice can enhance HCT processes for patients with COCCs.
- Multidisciplinary collaboration and patient-specific knowledge are key to successful HCT implementation.
Objective:
The growing number of adults with childhood onset chronic conditions (COCC) is reflected in the increase of adult-aged admissions to pediatric institutions. Despite national bodies advising pediatric institutions to have a pediatric to adult health care transition (HCT) policy, little guidance is available on if or how to include inpatient care. We sought to create a framework-based Pediatric to Adult Transitional Care in the Hospital Context (PATCH) tool to assess how inpatient care of adults is addressed in pediatric institutional guidelines or policies (hereafter guidelines) as a first step towards informing future PATCH guideline development.
Methods:
We used convenience and snowball sampling to obtain 11 pediatric institutional guidelines. Combining the GotTransition core elements with Coller et al's inpatient transition conceptual model through iterative consensus building, we developed the PATCH tool. Interrater reliability was assessed by using mean percent agreement among raters. A three-phase content validity process utilizing existing guidelines refined the finalized tool.
Results:
The PATCH tool included 42 items within nine domains. There was a high degree of agreeability among reviewers, and qualitative analysis revealed no missing items. Twenty-five (59%) of our 42 PATCH tool items were present in at least one of the reviewed guidelines, with age being present in all.
Conclusions:
We developed the PATCH tool as a guide for pediatric institutions regarding the care of adolescent and adult patients. The PATCH tool, embedded in multidisciplinary stakeholder discussion and patient- and system-specific knowledge, may help institutions incorporate HCT into processes for adolescent and adult patients with COCCs.
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