Background/Purpose The transition from pediatric to adult care is a vulnerable period. The lack of objective measures of transition readiness is a barrier to improving care.  The Transition Readiness Assessment Questionnaire (TRAQ) is a disease-neutral, patient-reported tool with 33 questions across 2 domains (self-management and self-advocacy). Items are scored on a 1 to 5 ordinal scale representing stages of change model (precontemplation, contemplation, preparation, action and maintenance). The TRAQ has not previously been assessed in adolescents and children with rheumatic or gastroenterologic (GI) conditions. 

Methods 89 adolescents and young adults (16 – 25 years) with chronic rheumatic, endocrine or GI conditions at a single pediatric center were enrolled. Participants completed surveys including demographics, transition experience, TRAQ. Clinical information was obtained via chart review. Data were analyzed with descriptive statistics.  Mean TRAQ scores were compared across specialty and age groups using one way ANOVA.

Results The 89 participants were 65% female, 18.3 years, 72% Caucasian, 86% non-Hispanic and had rheumatic (54%), GI (21%) or endocrine (23%) conditions (Table 1). The 50 participants with rheumatic diseases had JIA/RA (25), SLE or MCTD (13), vasculitis (6), overlap or other disease (6). Only 40% of participants reported discussing with current provider seeing an adult subspecialty provider in the future.  Participants reported seeing subspecialist independently for part of visit never (31%), rarely (15%), sometimes (20%), often (24%) or always (8%). TRAQ self-management and advocacy scores did not differ significantly by specialty but the TRAQ self-advocacy score increased with age (Tables 2 and 3).

Conclusion: Despite guidelines that transition processes begin at age 14, fewer than half of these 16-25 year old respondents reported ever discussing future transition to adult providers and almost 1/3 had never seen provider independently for portion of clinic visit. Mean TRAQ scores for this group represented the preparation stage of change.  The TRAQ is a promising tool for measuring transition readiness and can be used clinically and to assess intervention efficacy. These results underscore the need for improved transition processes for adolescents and young adults with chronic disease.  

 

Table 1:  Transition Readiness Assessment:  Participant Characteristics
Age, mean ± SD years	18.2 ± 1.6
Sex, no. (%) female	58 (65)
Race, no. (%) white	72 (81)
Ethnicity, no. (%) Hispanic/Latino	3 (3)
Current education status
Currently in school, no. (%) 9th to 12th grade, no. (%) College/Technical School, no. (%)	72 (82) 46 (52) 42 (47)
Highest Parental Education, no. (%)
Some high school    Graduated high school    Some college/technical school    Graduated college/technical school    Graduate degree    Unknown or not reported	3 (3) 20 (22) 27 (30) 28 (31) 9 (10) 2 (2)
Annual household income, no. (%)
<$25,000   $25,000 to 49,999   $50,000 to 74,999   $75,000 to 99,999   $100,000 to 150,000   >$150,000   Not reported/unknown	11 (12) 16 (18) 13 (15) 6 (7) 8 (9) 7 (8) 28 (31)
Employment
Not employed, no. (%)  Part time, no. (%)  Full time, no. (%)	47 (53) 36 (40) 6 (7)
Single, no. (%)	86 (97)
Insurance status
Parental private insurance, no. (%)   Personal private insurance, no. (%)   Public insurance, no. (%)   Other/unknown, no. (%)	58 (65) 0 28 (31) 3 (3)
Health condition, no. (%)
Rheumatic   Endocrine   Gastroenterologic	49 (56) 20 (22) 19 (21)
Duration of disease, mean ± SD years	5.0 ± 4.1
Time seeing current provider, mean ± SD years	4.2 ± 3.3
Self-Management TRAQ Domain 1, mean ± SD	3.16 ± 1.70
Self-Advocacy TRAQ Domain 2, mean ± SD	3.79 ±1.55
Abbreviations:  GI = Gastroenterologic; TRAQ = Transition Readiness Assessment Questionnaire

 

Table 2:  Transition Readiness Assessment Questionnaire Scores by Specialty
	Rheumatic (n=50)	GI (n=19)	Endocrinologic (n=20)	F	P value
Self-Management TRAQ Domain 1, mean ± SD	3.18 ± 1.70	3.14 ± 1.67	3.17 ± 1.72	0.09	0.91
Self-Advocacy TRAQ Domain 2, mean ± SD	3.78 ± 1.56	3.97 ± 1.46	3.63 ± 1.61	1.32	0.27
Abbreviations:  GI = Gastroenterologic; TRAQ = Transition Readiness Assessment Questionnaire

 

Table 3:  Transition Readiness Assessment Questionnaire Scores By Age
	16 to 18 years (n=51)	19 to 20 years (n= 28)	≥21 years (n=8)	F	P value
Self-Management TRAQ Domain 1, mean ± SD	3.01 ± 1.68	3.38 ± 1.71	3.38 ± 1.65	1.54	0.22
Self-Advocacy TRAQ Domain 2, mean ± SD	3.65 ± 1.57	3.90 ± 1.52	4.3 ± 1.39	4.24	0.02
Abbreviations:  TRAQ = Transition Readiness Assessment Questionnaire

 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-transition-readiness-in-adolescents-and-young-adults-with-rheumatic-and-other-chronic-health-conditions/