Background/Purpose: Transitioning children with chronic diseases from pediatric to adult healthcare can be a challenging task, with high morbidity and mortality. In response, we have developed a transition pathway called the Baylor Rheumatology Initiative: Developing and Guiding Engagement (BRIDGE). Through the BRIDGE, patients are introduced to a clinic-specific transition policy, and providers are incentivized to discuss transition planning beginning in early adolescence, with the goal of effective transition to an adult provider. The Transition Planning Tool (TPT) is an electronic medical record-based flowsheet; TPT use is encouraged at clinic visits for patients aged 14-19. Our objective was to assess baseline transition outcomes for a legacy group of transitioned patients and to assess the correlation between TPT utilization and the rate of successful transition.

Methods: Twenty-seven patients who transitioned during the establishment of the BRIDGE pathway were followed for 1 year post-transition to assess the characteristics of their transition. TPT data was reviewed retrospectively for each patient, examining extent of TPT use and completion of TPT elements. We rigorously defined the primary outcome of successful transition as meeting all 3 of the following criteria: 1) first adult rheumatology appointment within 3 months from last pediatric visit; 2) prescriptions refilled from the adult provider within 3 months from transition; and 3) no rheumatology-related emergency (ER) visits or hospital admissions within 1 year of transition. Comparisons were made using Wilcoxon rank sum, Chi-square, and Fisher’s exact tests.

Results: The majority of transitioned patients were female (78%) and privately insured (67%). The most common diagnosis was SLE (33%). Forty-four percent of patients met all goals for successful transition; 67% attended an adult appointment within 3 months (81% did within 4 months), 59% refilled medications within 3 months, and 85% avoided a rheumatology-related admission or ER visit within 1 year. There was no statistical significance between successfully transitioned patients and those who were not in number of times the TPT was accessed, number of unique TPT questions successfully answered, age, sex, diagnosis, insurance type, or disease severity. However, unadjusted logistic regression indicated that completion of some TPT questions, specifically #8 regarding alcohol/non-prescription drug use and #13 knowing who the adult provider will be, was associated with a higher probability of successful transition.

Conclusion: Although there is no significant link between TPT use and successful transition in this legacy cohort, there are some positive signals. For our next step, we will compare these outcomes to those of patients who have been in our formalized BRIDGE program for 1 year or longer before transition. Additionally, over the next quality improvement cycle, we hope to achieve successful transition metrics for 75% of our patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-patient-transition-outcomes-from-a-large-pediatric-rheumatology-center-to-adult-healthcare/