Background/Purpose: Transitioning children with chronic diseases from pediatric to adult care can be challenging. Patients are faced with the emotional shock of entering a new healthcare environment, along with the many technical burdens of learning how to navigate a complex new system. It is no wonder that both morbidity and mortality are higher in the time surrounding transition to adult care.

Fortunately, there is a movement to create standardized processes which empower patients to take ownership of their care. At our institution, rheumatology is a leader in this space. We have utilized the 6 core elements from “GotTransition” to develop a transition pathway. This included the creation of a transition policy (element 1), as well as a data registry to track patients (element 2). The utilization of a transition planning tool, or TPT, allows for progress on readiness and planning (elements 3 and 4). The TPT is an electronic medical record (EMR) based flowsheet which helps guide providers in preparing patients for transition across multiple domains including medications, appointments, refills and insurance.

The aim of this project was to increase transition readiness and planning by increasing TPT use. We did this by tracking and encouraging TPT use or acknowledgement by providers in our rheumatology clinic.

Methods: In January 2019, a best practice alert (BPA) was created and embedded into the EMR to serve as a reminder for rheumatology providers to use the TPT with their transition aged patients (1567 patient encounters). Providers could also acknowledge why they didn’t use the TPT. Use of the tool was refined through a series of PDSA cycles. The first PDSA cycle was used to gather baseline data to determine how the BPA influenced TPT use. The second cycle involved encouraging providers to utilize the tool at regular section meetings. In the third cycle, we worked to optimize integration of the BPA into the EMR. In the fourth cycle, transition coordinators were present at a majority of clinic sessions, serving as a reminder to use the TPT.

Results: There was a statistically significant increase in TPT use over time from the beginning to the end of the year (p< 0.001). TPT use plateaued around July 2019, with usage at 45% of eligible patient visits, up from only 16% of visits in January. If both use and acknowledgement are considered, the TPT was addressed in 95% of patient visits in July, up from only 24% in January. The two most common acknowledgements from providers who did not use the TPT were an active disease flare, in which the provider focused on acute issues (15% of acknowledgements), and clinic being too busy to utilize the TPT (32% of acknowledgements).

Conclusion: Our data suggests that a BPA incorporated into provider workflow is an effective means to promote transition planning using a TPT. As providers frequently cited time constraints as a key limitation in utilization of the TPT, we are working on securing dedicated transition support to achieve standardized transition readiness and planning. Going forward, we plan to finalize our transition pathway (transfer and completion, elements 5 and 6), and monitor outcomes, such as whether increased TPT use correlates with more successful transition into adult care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-a-best-practice-alert-to-encourage-transition-planning-and-readiness/