A Standardized Approach to Transition Improves Care of Young Adults with Inflammatory Bowel Disease

Young adults with inflammatory bowel disease (IBD) are at the risk of poor outcomes when transferring to adult providers. We aimed to increase the percentage of patients with 14-17 years of age undergoing the transition of care and the percentage of patients 18-21 years of age initiating the transfer of care to 50% for 12 months. Our goal was also to improve patient satisfaction with the transfer process. Our balancing measure was not to increase the duration of IBD visits.

We implemented 3 interventions through iterative plan-do-study-act cycles. To understand the impact of the interventions for 12 months, we used statistical process control charts. The duration of IBD visits was used as a balancing measure. We administered an anonymous satisfaction survey through the electronic health record.

Total transition discussions increased to a mean of 38% (n = 68). Transition discussions with patients 14-17 years of age increased from baseline, though not consistently. Patients 18-21 years of age initiating transfer of care increased to a mean of 5% (n = 1) following the first intervention and to a mean of 30% (n = 13) following our second and third interventions with special cause variation. There was no significant difference in the duration of IBD visits before and after the intervention period (P = 0.54). No patients were dissatisfied following our interventions.

We saw improved transition discussions and transfer initiation rates by implementing the first steps of a new process to transition young adults with IBD.