O3220: Optimizing the Process of Transition from Pediatrician to Adult Primary Care Through Communication

Purpose/Objectives: Approximately 18 million U.S. adolescents will transition into the adult healthcare system in the next few years, however many barriers to successful transition exist. Two barriers frequently cited are the lack of adult providers and lack of communication between providers. The fifth core element from Got Transition recommends establishing a method for transfer including communication and coordination between pediatric and adult clinicians. For adult providers, a warm hand-off is critical for taking over the care of complex pediatric patients. We aimed to create a transition model and referral process that would allow for improved access to adult providers and improved communication between pediatric and adult providers.

Design/Methods: Our adult primary care clinic is housed within a primary care medical home with robust support staff. The intention of our transition model was to accept patients from Pediatrics Comprehensive Care Program, a clinic for children with complex chronic conditions, medical fragility, or technology- dependence. The patients would be referred through the electronic medical system, tracked by referral code, and scheduled into specific clinic slots so a team including two med-peds physicians could huddle pre-visit. This huddle would include review of a medical summary sent from referring provider and communication with clinic support staff as needed. The framework and concept were presented to the General Pediatrics Division monthly meeting with a planned go live date for July 1, 2022.

Results: Transition occurred via formal referral process, word of mouth, e-mails and electronic medical record messaging. Eleven patients transitioned to adult primary care through word of mouth or self-referral. None of these patients were scheduled into allocated slots, nor was a medical summary available from the previous provider. We had three formal referrals placed. Of these, one patient no showed and the other two were never scheduled. We received seven emails and two patients were seen in clinic, three have upcoming scheduled appointments and two others have not yet scheduled. Two messages came through the electronic medical record but neither of these patients were scheduled as they did not meet criteria for our model.

Conclusion/Discussion: Patients are finding our providers for transition to adult primary care. However, our transition model did not yield improved organization in transition. There was increased communication in the case of emailed referrals where medical synopsis was included but not with formal referrals. Standardization within and across institutions regarding methods of transition and handoff processes between pediatric and adult providers would be helpful in addressing transition barriers. However, the most effective ways to approach this needs to be further explored.