Background/Purpose: For many patients with childhood onset disease, the transition from pediatric to adult healthcare is difficult, often resulting in lapses in care and increased disease activity and morbidity. Texas Children’s Hospital pediatric rheumatology clinic has instituted measures to improve preparedness for transfer to adult rheumatology including introduction of a policy, tracking eligible patients, using a transition planning tool, and self-assessment of preparedness. We have instituted a formal acknowledgment for patients at the last pediatric visit to emphasize the care transfer event, which includes finalization of a transition summary letter given to the patient to help prevent loss of information when establishing care with adult rheumatology.

Methods: Emails were sent to providers, initially biweekly then weekly, identifying all transition-age patients and reminding providers to discuss transition from February 2023 to April 2024. Those ages 17 and older were emphasized due to their more imminent transfer of care to adult rheumatology. Retrospective review of the electronic health record (EHR) was used to assess transition status. Patients were grouped by those who had a scheduled appointment with an adult rheumatologist and a transition summary letter, those whose pediatric provider identified the visit as the final pediatric visit but did not create a transition summary letter, and those for whom specific transfer of care was still pending.  We also tracked whether the provider documented discussing transition. We aimed to acknowledge at least 90% of patients transitioning from rheumatology clinic to adult healthcare, marked by a transition summary letter, between February 2023 to April 2024.

Results: From February 2023 to April 2024, 1151 potential final pediatric visits were identified, 733 (63.7%) of notes documented discussion of transition at the visit, and a total of 127 patients were identified as ready to transition. Of those, 91 patients (71.6%) received a summary letter.

Conclusion: During the transition from pediatric to adult care, many patients experience flares and lapses in care. We continue to build on transition pathway work conducted within pediatric rheumatology in order to help provide a sense of closure and consolidate information for adult providers. 71.6% of eligible patients have received a transition summary since the institution of this initiative, which should help prevent loss of information between providers. We aim to continue to follow patients longitudinally to assess the impact of this intervention on the successful transfer of care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pediatric-rheumatology-graduation-a-one-way-bridge-to-adult-care/