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 – noticed pediatric
patients “falling off records” or ending up in ER for episodes which
could have been prevented

4. • 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

5. HCT Index – Provider Survey

6. Workflow Overview
For any office visit over age 12 (12-19 yo)
that is not acute in nature:
1. New Document
2. Select Encounter Type (2 with new form)
3. Check “Transition of Care, Peds to Adult” checkbox
4. Click Adolescent Transition of Care button (right)
5. Have age-appropriate conversation regarding
transitioning using the form as a guideline
6. Fill out Y/N questions in the form that correspond with
patient’s age range
7. Enter comments as clinically indicated
8. Continue with visit as usual and sign note
9. Review information in the patient’s medical record

8. 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

10. For children ages 12-16 (no
checkbox)

11. Adolescent Transition of Care Form
• Added to two office visit types:
– PEDS Chronic
– PEDS Well-Child (+1 year) – Physicals
– Any others needed?
• 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

12. Adolescent Transition of Care Form

13. Form Questions (Domain 1)
• Increasing Adolescent Responsibility for Healthcare
Management
• Age 12-13 Years
 Met privately with the adolescent for part of the office visit.
 Adolescent demonstrates understanding of his/her
conditions and how to take any prescribed medications.
 Adolescent asks questions during each office visit and
participates in the care plan.
• Age 14-16 (continues on 17-19)
 Adolescent is competent in independently making
appointments, filling prescriptions, following up on referrals,
and seeking emergency services, as needed.
 Adolescent's parents were provided with the opportunity to
discuss their feelings about loss of control, concerns about
the future, and increasing the adolescent's independence.
 Discussed using technology to access health records and
communicate with the adolescent's care team.

14. Form Questions (Domain 2)
• Readiness Assessment for Transfer to Adult
Care
• Age 12-13 Years
Initiated discussion about transfer to an adult
healthcare provider. Provided copy of transition policy
and letter.
• Age 14-16 Years
Discussed choices for adult care and assisted in
identifying possible care providers.
• Age 17-19 Years
Discussed plan for health insurance coverage in the
future.
Encouraged to meet and interview adult providers.
Initiated communication with the adult provider that the

15. Form Questions (Domain 3)
• Implementation of Transfer to Adult
Care
• Age 17-19 Years
Transferred health records.
Discussed nuances of care with the adult
provider.
Followed up after the transfer.

16. Patient Medical Record

17. Discussion
• Does this workflow seem manageable for you to
complete while rooming the patient and doing the initial
intake?
• What issues do your foresee in implementing this form
in practice?
• How do you think parents will respond to these
questions being asked?
• How do you think adolescents will respond to these
questions?
• What educational handouts might you need to
supplement the discussion?

18. QUESTION
S?

19. 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.