There comes a point in every patient’s life when they age-out of pediatric care and must transition into the adult healthcare system. Ineffective transitions or “hand-offs” in healthcare are often linked to lapses in communication that can lead to adverse events or poor outcomes.
In fact, according to the Joint Commission Center for Transforming Healthcare, an estimated 80 percent of serious medical errors involve miscommunication between caregivers during the transfer of patients between care settings. An often-overlooked transitional point is the period when adolescents transition to adult healthcare.
Research shows that many young adults have significant time gaps between their last pediatric visits and their first visit to an adult healthcare provider. This lack of continuity can pose risks for patients, particularly those who have health conditions that require follow-up care.
Understanding how to effectively transition pediatric patients to the adult healthcare system with strategic policies and education can help physicians better care for their patients and avoid adverse outcomes.
Young Adult Vulnerability
Adolescents tend to be healthier than many other age groups, but the National Academy of Medicine and the National Research Council reports that young adults exhibit worse health than both younger adolescents and older adults.
The research found that young adults, as compared with other age groups, have the highest rate of death and injury from motor vehicles, homicides, mental health problems, sexually transmitted infections (STIs), and substance abuse. The study also revealed that most of the leading causes of illness and death among young adults are largely preventable, making care continuity particularly important for this age group.
The healthcare system is complex, and holistic care is rarely provided in a single setting throughout a patient’s lifetime. When transitioning between pediatric and adult care, the risk of poor coordination is high without reliable processes to ensure continuity of care and communication among the healthcare team. The key to ensuring a smooth transition of care is early education and support.
The American Academy of Pediatrics (AAP) advises parents and their providers to begin planning for transition as early as age 12 by educating patients and caregivers on transition policies and procedures. They advise parents to plan for the move to an adult doctor between ages 14 and 18. For children with pediatric onset conditions, mental health conditions, and those with developmental or intellectual disabilities, more in-depth planning may be needed for any specialists involved in their care. Even when adolescents seeing a family physician may stay in the same practice, they may still need to transfer specialty care to adult sub-specialists.
A Strategic Approach
In 2018, the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and American College of Physicians (ACP) updated their guidance document, “Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home.” This guidance outlines steps pediatric practices can take to ensure a smooth transition from pediatric to adult primary care.
The guidance offers a framework for practices that defines the basic components of healthcare transition support. These components include establishing a policy, tracking progress, administering transition readiness assessments, planning for adult care, transferring, and integrating into an adult practice.
Based on this guidance, we recommend pediatric healthcare providers take the following steps to proactively mitigate risks associated with the transfer of care:
- Develop a policy on transitions to adult medicine
- Provide guidance for parents on when/how the transition will occur
- Perform a transition readiness assessment for adolescents
- Encourage and educate patients on the need for self-care
- Solicit patients’ involvement in healthcare decision-making
- Provide recommendations related to preventative health needs for young adults
- Reconcile medications at each patient encounter
- Obtain medical records from any emergency care/urgent care visit
- Reconcile all reports from consultants/specialists and diagnostic test results
- For patients with high-risk conditions, confirm that the patient has safely transitioned to an adult provider
- Provide complete medical records to adult provider
For further guidance on this issue, Curi members are also encouraged to reach out to our Claims and Risk Management Departments at 800.662.7917.
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