Healthcare Transition in Adolescents with Heart Disease: Assessing Transition Readiness

Abstract

Problem & Purpose: The American Heart Association, American Academy of Pediatrics, and American Academy of Family Physicians recommend the use of formal transition interventions to support adolescent and young adult (AYA) patients transitioning to adult care. Within a pediatric cardiology clinic in an urban, academic medical center approximately 25% of the patient population is over the age of 16 years. The clinic has no structured transition policy or program and only 2.4% of these patients received documented transition education. The purpose of this quality improvement project was to implement a transition readiness assessment with the goal of ensuring 100% of eligible patients received transition education or appropriate referral to adult services. Methods: Implementation occurred over a 17–week period. Patients over 16 years with ongoing cardiac needs and stable treatment plans were eligible; patients new to the practice were excluded. During a routine cardiology appointment, eligible patients received an introductory letter and QR code for self-administration of the Transition Readiness Assessment Questionnaire (TRAQ). Following completion of the TRAQ tool, a nurse practitioner reviewed the readiness score, and patients received a transition focused appointment or referral to adult services, as appropriate. Eligibility was determined and demographic data obtained via chart audits. Results: Adherence to delivery of the TRAQ tool to eligible patients was high (88%). A total of 17 of 52 eligible patients elected to participate by completing the readiness assessment (n=17). Chart audits of the implementation period demonstrate 35% of patients 16 years and older having documented transition education or referral to adult care. Conclusions: Successful change in practice at the site demonstrates the feasibility of transition initiatives. Findings suggest that implementation of a transition readiness assessment can increase appropriate management of AYA patients.