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A novel score for transition success of pediatric rheumatology patients
Kyla Blasingame1, David McDonald1, Miriah Gillispie-Taylor1,2,3
1Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
Insights
A new transition success score was developed for pediatric rheumatology patients. While 75% achieved 3 or 4 success components, opportunities for improving healthcare transition remain.
Area of Science:
- Rheumatology
- Adolescent Health
- Healthcare Transition
Background:
- Assessing healthcare transition success is challenging due to a lack of patient-level metrics.
- Existing transition readiness scores do not fully capture transition outcomes.
- A validated metric is needed to evaluate interventions aimed at improving healthcare transition.
Purpose of the Study:
- To develop and validate a novel patient-level transition success score for pediatric rheumatology patients.
- To establish a quantifiable measure for evaluating the effectiveness of healthcare transition programs.
- To identify key components indicative of successful transition from pediatric to adult care.
Main Methods:
- A four-component transition success score was created in consultation with experts.
- Components included attending initial/second adult appointments, medication refills, and absence of rheumatology-related ER visits.
- Scores were determined through retrospective electronic medical record (EMR) review.
Main Results:
- A transition success score was applied to 198 pediatric rheumatology patients.
- 36% achieved optimal transition success (all 4 components), and 39% met 3 components.
- Gaps were identified, particularly in attending a second adult appointment (only 80% met this component).
Conclusions:
- A novel transition success score effectively measures healthcare transition outcomes in pediatric rheumatology.
- While a majority of patients achieved some success, significant opportunities exist to enhance the transition process.
- Future research will correlate this score with transition program elements to identify predictive factors for success.
Background:
Success of transition from pediatric to adult care depends on many factors. Various scores for transition readiness have been developed, but few patient-level transition success scores exist. Without such a metric, it is difficult to assess the impact of programmatic interventions to improve the process of healthcare transition. We created a novel transition success score for pediatric rheumatology patients.
Methods:
Pediatric rheumatologists consulted the literature and adolescent health experts. Four components were included in the final score: attending a first adult appointment in the time frame designated by the pediatric rheumatologist (component 1), refilling medications with the adult provider within 3 months of the first adult appointment (component 2), no rheumatology-related emergency department visits in the first year after transition (component 3), and attending a second adult appointment (component 4). Scores were determined via retrospective electronic medical record (EMR) review. Each component was weighted as one-quarter of the total transition success score.
Results:
From 2017-2024, we identified 357 patients with a final visit to pediatric rheumatology using a combination of direct provider notification of transition and EMR review. Of those, EMR records were available to score transition success for 198 patients. Optimal transition success (ie achievement of all 4 components of successful transition) was accomplished by 72/198 (36 %) patients; 77/198 (39 %) patients scored 75 %. Only 3 patients (1.5 %) scored 0 %. When considered by component, 113 patients (57 %) met component 1, 150 (76 %) met component 2, 165 (83 %) met component 3, and 159 (80 %) met component 4. We were unable to document attendance at a second adult rheumatology appointment for a surprising 20 % (39/198) of transitioned patients.
Conclusions:
We have developed a transition success score and applied it to an initial cohort of patients who transitioned from our pediatric rheumatology clinic. Although 149/198 patients (75 %) fulfilled 3 or 4 out of 4 components of successful transition, we have identified clear opportunities for improvement. Our next steps include evaluating components of our transition program, such as patient self-reported transition readiness or receipt of a transition summary letter, against the transition success score to better understand which factors predict successful transition.
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