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The Transition Care Index: Standardizing comprehensive transition and transfer for young adults with inflammatory
Hilary K Michel1,2, Jennifer L Dotson1,2,3,4, Jennie G David1,5
1Department of Pediatrics The Ohio State University College of Medicine Columbus Ohio USA.
Insights
Implementing the IBD Transition Care Index improved care standardization for young adults with inflammatory bowel disease (IBD) during their transition to adult care. This quality improvement initiative increased the completion of key care variables and multidisciplinary visits.
Area of Science:
- Quality Improvement in Healthcare
- Pediatric to Adult Transition of Care
- Inflammatory Bowel Disease Management
Background:
- Young adults with inflammatory bowel disease (IBD) face high risks during the transition from pediatric to adult care.
- Standardizing care and improving preparation are crucial for better outcomes in this vulnerable population.
Purpose of the Study:
- To implement quality improvement (QI) methods to standardize care for young adults with IBD during their transition to adult services.
- To decrease care variation and enhance preparation for young adults moving from pediatric to adult IBD care.
Main Methods:
- Development of the IBD Transition Care Index (TCI), a 10-variable measure assessing comprehensive transition preparation.
- Education of patients, caregivers, and providers on TCI completion and its importance.
- Systematic recording and regular review of TCI variable completion rates.
Main Results:
- The mean percentage of TCI variables completed increased from 62% to 71% post-intervention.
- A significant increase in multidisciplinary IBD annual visit attendance was observed (51% vs. 62%).
- Patients under general gastroenterology physicians showed significant improvements in TCI completion and annual visit attendance.
Conclusions:
- Care Indexes like the TCI can effectively reduce variability and standardize the complex transition process for young adults with IBD.
- Standardization of care through tools like the TCI aims to ultimately improve patient outcomes in IBD transition.
Objectives:
In young adults with inflammatory bowel disease (IBD), the time following transfer to adult care is high-risk for adverse outcomes. We used quality improvement (QI) methods to standardize care, decrease variation, and improve preparation of young adults during the transition/transfer process.
Methods:
We created the IBD Transition Care Index (TCI), a list of 10 variables whose completion was felt to represent a more comprehensive transition/transfer process. Variables were organized into three domains: Disease Control/Physical Health, Psychosocial Well-being, and Transition/Transfer Preparation. We educated patients, caregivers, and providers on the value of completing the TCI to deliver complete, multidisciplinary preparation. We recorded variable completion in a database, reviewed results regularly with providers, and compared rates of variable completion between IBD-focused and general gastroenterology (GI) physicians.
Results:
Three hundred twenty-two patients transferred to adult care during the project period (211 pre-intervention and 121 post-intervention). In the overall cohort, the mean percentage of TCI variables completed increased from a baseline of 62%-71% in the post-intervention period, with a significant increase in the rate of multidisciplinary IBD annual visit (IBD AV) attendance (51% vs. 62%, p = 0.03). Patients cared for by general GI physicians had significantly increased rates of both overall TCI variable completion (54% vs. 72%, p = 0.02) and IBD AV attendance (34% vs. 57%, p = 0.02) in the pre- versus post-intervention period.
Conclusions:
Care Indexes such as the TCI can be used to reduce variability and standardize complex clinical processes like transition/transfer for young adults with IBD, with the goal of improving patient outcomes.
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