1. Supporting the Transition from
Pediatric to Adult Health Care

2. • Definition of Health Care Transition: The purposeful, planned and
timely transition from child and family-centered pediatric health
care to patient-centered adult-oriented health care. (Society for
Adolescent Medicine, 1993)
• The goal of a planned health care transition is to maximize
lifelong functioning and well-being for all youth, including those
who have special health care needs.
• Only about 50 percent of parents report discussing their
adolescents’ changing health care needs with a pediatrician, and
of those only 42 percent had discussed switching to an adult
provider. (Pediatrics, 2009)
• Identified as a need by IPCA and RH staff

3. • A comprehensive and coordinated transition to adult care
makes for better outcomes for children and young adults
• Early education about transitioning helps youth feel more
comfortable with taking on new responsibilities and more
empowered when it comes to their own health
• Successful transitions can help prevent readmissions to the
hospital in young adulthood (18-24)
• Transitioning to another RH provider helps with continuity of
care and keeps children in one system

5. • Part 1: Quality Improvement Initiative
– Patient Centered Medical Home Designation
• 5C: Coordinate With Facilities and Care Transitions
• “Collaborates with the patient/family to develop a written care plan for
patients transitioning from pediatric care to adult care”
– Pilot at River Hills Community Health Center (Pediatric
Clinic)
• Part 2: Develop Transitioning Toolkit – to be used
by providers at all community health centers across
Iowa

7. Transition of Care Checkbox
*On Initial Intake form, Care Management Plan form, and Pediatric CC/HPI form
**Currently shows up at age 16 – working to change it so checkbox appears at age 12

9. Adolescent Transition of Care Form
• Added to two office visit types:
– PEDS Chronic
– PEDS Well-Child (+1 year) – Physicals
• 14 Yes/No Questions broken down into three age ranges
• 3 Domains
– Increasing Adolescent Responsibility for Healthcare
Management
– Readiness Assessment for Transfer to Adult Care
– Implementation of Transfer to Adult Care
• Gradually complete questions as child moves through
adolescence

10. Adolescent Transition of Care Form

11. Patient Medical Record

12. HCT Index – Provider Survey

13. Other Transition Toolkits
• http://newenglandconsortium.org/for-
families/transition-toolkit/
• http://rwjms.rutgers.edu/boggscenter/product
s/BeingaHealthyAdultHowtoAdvocateforYourHe
althandHealthCare.html
• http://healthytransitionsny.org/skills_media/to
ol_show

14. Discussion
• What are you already doing in your clinical practice to
support this transition period? How do you think it
could be improved?
• How do you think parents will respond to these
questions being asked?
• How do you think adolescents will respond to these
questions?
• What educational materials might you need to
supplement these discussion?

15. THANK YOU!

16. References
• Lotstein, Debra S., et al. "Planning for health care transitions: results
from the 2005–2006 national survey of children with special health
care needs." Pediatrics 123.1 (2009): e145-e152.
• Cooley, W. Carl, and Paul J. Sagerman. "Supporting the health care
transition from adolescence to adulthood in the medical home."
Pediatrics 128.1 (2011): 182-200.