Background/Purpose: The BRIDGE (Baylor Rheumatology Initiative: Developing and Guiding Engagement) program is a quality improvement initiative to develop a safe, comprehensive pathway for our patients into adult rheumatology care. In designing this pathway, we utilized the core elements from gottransition.org. To accomplish elements 3 and 4, readiness and planning, our program utilizes a Transition Planning Tool (TPT), an electronic medical record (EMR)-based flowsheet that guides providers preparing patients for transition across multiple domains. In our prior analysis, components of the TPT correlated with improved transition outcomes. For both providers and patients, telemedicine is among the most profound changes stemming from the COVID-19 pandemic. Though telemedicine has made rheumatology care more accessible, we aimed to determine its impact on TPT use.

Methods: TPT utilization is encouraged via a Best Practice Alert (BPA), which was incorporated into the EMR in January 2019. Provider use of the TPT for eligible patients is tracked via the BPA, allowing for quality improvement cycles to promote these important transition conversations. The visit type (telemedicine versus office visit) is also tracked. We compared how frequently providers addressed transition using the TPT in both office and telemedicine visits. We also analyzed TPT use across telemedicine visits throughout the pandemic.

Results: From January 2020 to December 2021, transition planning was addressed using the TPT in 69% of all eligible visits, including both telemedicine and office visits. This was compared to 24% of eligible office visits in early 2019 when we began using the TPT BPA. Telemedicine began in May 2020, immediately comprising 36% of visits. This peaked in July 2020, wherein nearly 89% of all outpatients seen by pediatric rheumatology were via telemedicine. Telemedicine continues to be regularly used for 20% of visits. When comparing all eligible outpatients seen in person to those seen virtually between May 2020 and December 2021, there is no statistically significant difference in how often the transition planning was addressed using the TPT (p=0.215).

Conclusion: The pandemic created a significant pivot point in how rheumatology care is delivered. Fortunately for our patients, we found the introduction of telemedicine did not hinder the transition preparation conducted during eligible visits, as the TPT is addressed just as frequently during telemedicine as during office visits. The convenience that telemedicine affords is a tremendous benefit to our pediatric rheumatology patients. Going forward, we plan to investigate if telemedicine can be used for the sole purpose of addressing transition using dedicated virtual transition visits. As we continue to track the relationship between TPT use and successful transition into adult care, we can now investigate whether virtual transition planning leads to the same outcomes as in person.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/planning-transition-in-times-of-transition-is-there-a-virtual-pathway-from-pediatric-to-adult-care/