Background/Purpose: Pediatric rheumatology patients need effective transition from pediatric to adult providers. Texas Children’s Hospital (TCH) rheumatology clinic providers have developed a transition pathway, the BRIDGE (Baylor Rheumatology Initiative: Developing and Guiding Engagement), based on defined elements of transition and utilizing an electronic medical record-based transition planning tool (TPT) to help with transition preparation.

Methods: The validated, self-administered Adolescent Assessment of Preparation for Transition (ADAPT) survey generates 3 composite scores (out of 100) for counseling on transition self-management and prescription medications, and on transfer planning. Return adolescent patients aged 14-19 years were surveyed regardless of diagnosis. Surveys were emailed via a REDCap database on the morning of clinic appointments between August-December 2018 and November 2019-May 2020. Surveys were scored and analyzed against demographics.

Results: 302 patients completed at least 1 survey. Serial surveys were collected on 59 respondents. Most respondents were female (71%) and white (75%); 42% were Hispanic. Most patients were privately insured (57%) or covered by Medicaid/Children’s Health Insurance Program (38%). The most common diagnosis was juvenile arthritis (30%).  Average initial ADAPT scores for all respondents were 37/100 for transition self-management, 66/100 for medication management, and 17/100 for transfer planning. Scores in all three domains increased with increasing patient age at first ADAPT survey (p< 0.001). Survey scores in self-management increased by 17 for each year since the first survey (p< 0.001), medications increased by 16 for each year since the first survey (p< 0.001), and transfer planning by 23 for each year since the first survey (p< 0.001). For transfer planning, higher patient age at first ADAPT survey was associated with larger increases in score over time. We noted that, on average, privately insured patients had 11-point lower initial scores in self-management than publicly insured patients (p=0.029). Further, we noted that, on average, English speaking patients scored 22 points lower on self-management and 20 points lower on medications than non-English speakers (p=0.001).

Conclusion: Our clinic has developed a method to assess patient self-reported transition readiness. Our data indicates that participating patients improved over time in all domains measured by the ADAPT survey. Going forward, we plan to analyze outcomes of transitioned patients to assess the efficacy of our pathway. Our ultimate goal is to create a sustainable and successful BRIDGE between pediatric and adult rheumatology care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-patient-self-reported-transition-readiness-in-a-large-pediatric-rheumatology-center-2/