Find Established Evidence

Displaying records 1 through 20 (26 total).

Agarwal S, Raymond JK, Schutta MH, Cardillo S, Miller VA, Long JA. An adult health care-based pediatric to adult transition program for emerging adults with type 1 diabetes. The Diabetes Educator. 2017 Feb;43(1):87-96. doi:10.1177/0145721716677098.

Link: https://pubmed.ncbi.nlm.nih.gov/28118128/

NPM: 12: Transition
Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Pediatric to Adult Transfer Assistance, Planning for Transition, PROVIDER/PRACTICE

Intervention Results:

The findings of this study demonstrate that a transition program for emerging adults (EAs) with type 1 diabetes based in an adult health care system can 1) improve health outcomes, such as glycemic control and BGMF, 2) retain EAs in care, and 3) be acceptable to participating patients and providers. From baseline to 6 months, mean A1C decreased by 0.7% (8 mmol/mol), and BGMF increased by 1 check per day. Eighty-eight percent of participants attended ≥2 visits in 6 months, and the program was rated highly by participants and providers (pediatric and adult).

Bennett AL, Moore D, Bampton PA, Bryant RV, Andrews JM. Outcomes and patients’ perspectives of transition from paediatric to adult care in inflammatory bowel disease. World Journal of Gastroenterology. 2016 Feb 28;22(8):2611-2620. doi: 10.3748/wjg.v22.i8.2611

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4768207/

Intervention Results:

Although there were no significant differences in health outcomes between the transition and non-transition cohorts, the majority (44/46, 96%) of the transition cohort felt that a structured transition plan was important. Non-transition patients also endorsed this statement (32/35, 91%). The transition cohort identified 1) the task of establishing a new relationship with a practitioner, 2) lack of communication, and 3) patients’ own lack of understanding of IBD as potential barriers to successful transition. Similar responses were proposed by the non-transition group. The majority of transition respondents thought that the timing of transition should be “age 18 years,” compared with the non-transition cohort who nominated “patient readiness.” The majority of study participants were regularly reviewed by a gastroenterologist [42/46 (91%), transition patients and 30/35 (86%), non-transition patients]. Among transition patients reviewed, 15% were reviewed 3 monthly or more often, 60% 6 monthly and 25% annually. Utilization of members of other the multi-disciplinary team was generally low in both cohorts, except for their general practitioners.

Burns K, Farrell K, Myszka R, Park K, Holmes-Walker DJ. Access to a youth- specific service for young adults with type 1 diabetes mellitus is associated with decreased hospital length of stay for diabetic ketoacidosis. Internal Medicine Journal. 2018;48(4):396-402.

Link: https://pubmed.ncbi.nlm.nih.gov/29034986/

Intervention Results:

Those who were supported by youth-specific diabetes services had a better outcome with less severe DKA at presentation and a shorter length of stay (LOS). There was a statistically significant (P < 0.05) shorter LOS of 1.5 days in patients who were supported by a youth-specific diabetes clinic. Based on a difference in median LOS of 1.5 versus 3.0 days in supported versus unsupported arms, and a total number of admissions in 2011 of 10 versus 45, respectively, the estimated cost saved by the transition service using reduction in bed days alone was $250,500. Additionally, the researchers found a significant difference in pH at admission, potentially reflecting milder DKA at presentation in those youth with diabetes (YWD) supported by a youth specific diabetes service. Unsupported youth were 4 times more likely to be admitted/readmitted to the hospital.

Cappelli M, Davidson S, Racek J, et al. Transitioning youth into adult mental health and addiction services: An outcomes evaluation of the youth transition project. Journal of Behavioral Health Services Research. 2016;43(4):597-610. doi:10.1007/s11414-014-9440-9.

Link: https://pubmed.ncbi.nlm.nih.gov/25292462/

Intervention Results:

Evaluation of the shared management model for youth transitions showed positive results in shortening transition times, with decreases seen over each subsequent program year. However, mixed results were seen in the distribution of youth who transitioned, with close to 60% of youth being seen by adult providers while the rest remained on waitlists or canceled services. The results demonstrate that the sample of youth enrolled in the program were in high need of services, fulfilling the objective of the Youth Transition Project in identifying an appropriate group of youth in need of transition. The Youth Transition Project also achieved the objectives of providing counseling services to youth and coordinating their transition to AMHS. Of the 215 young people seen by the transitions coordinator over an 18-month period, 127 completed their transition and were seen by an AMHS provider; 41 had yet to transition and remained on a waitlist for AMHS; and 47 youth canceled services (declined further services, did not return phone calls, or moved away) and did not complete their transition: 16 canceled services after being seen by the coordinator while 31 canceled after being referred to AMHS. Youth who transitioned reported being more psychologically distressed and displayed more significant internalizing disorders. These youth may have shown a greater need for immediate treatment or were potentially given priority over those displaying a lesser degree of urgency. It took an average of 100 days for youth to transition to AMHS. significant internalizing disorders. These youth may have shown a greater need for immediate treatment or were potentially given priority over those displaying a lesser degree of urgency. It took an average of 100 days for youth to transition to AMHS. Chi-square tests revealed that a significantly greater proportion of transitioned youth had a greater number of prior emergency department visits, and that canceled youth scored significantly higher on the ANSA’s measure of antisocial behavior. Also, a greater proportion of canceled youth were diagnosed with Anxiety Disorder Transition times for youth significantly differed across AMHS provider, and they were significantly longer for youth referred to project-partner AMHS than for youth referred to non-project-partner AMHS. The distribution of youth seen by project-partner providers was as follows: general hospitals (English: 15.0%; n=19; French: 4.7%; n=6); mental health centers (38.6%; n=49); community youth service agencies (6.3%; n=8), and substance abuse treatment centers (3.1%; n=4); and non-project partners (32.3%; n=41). Significant differences were also found between project partners and non-project partners for youth’s reports on questionnaire measures. On the OCANSelf assessment, youth seen by project partners reported significantly more unmet needs than those seen by non-project partners on items related to time spent on activities, physical health, psychological distress, and intimate relationships. Youth referred to the program presented with various mental health disorders and other problems, including anxiety (71%), mood disorders (62%), substance-related disorders (21%), and disorders usually first diagnosed in infancy, childhood, or adolescence (~40%). The majority of youth were currently on medication and had other health conditions aside from their mental illness. At the time of initial referral, 78.7% (n=133) of youth lived with their parents, 6.5% (n=11) in shelters or were homeless, 5.9% (n=10) on their own, 4.1% (n=7) in group homes, 2.4% (n=4) with relatives or friends, 1.8% (n=3) with a grandparent, 0.6% in foster homes (n=1), and 14.1% (n=31) of youth were involved with a child welfare agency.

Colver A, McConachie H, Le Couteur A, et al. A longitudinal, observational study of the features of transitional healthcare associated with better outcomes for young people with long-term conditions. BMC Medicine. 2018;16(1):111. Published 2018 Jul 23. doi:10.1186/s12916-018-1102-y.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055340/

NPM: 12: Transition
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Care Coordination, Integration into Adult Care, Pediatric to Adult Transfer Assistance, Planning for Transition

Intervention Results:

Of the 9 Proposed Beneficial Features (PBFs) of transitional healthcare, recommended in policy documents, 3 PBFs had significant positive associations with better outcomes, namely appropriate parent involvement, promotion of health self-efficacy, and meeting the adult team before transfer. The other 6 PBFs had few statistically significant positive associations with better outcomes in the year-by-year analysis, had a number of negative associations, and had no positive associations with the consolidated indicator of exposure to PBFs. Two of the three key features which help (appropriate parent involvement and promotion of health self-efficacy) are not specific to transitions; rather, they are features of developmentally appropriate healthcare for all young people. This finding reinforces the view that much of the essence of good transitional care is actually good developmentally appropriate healthcare. Additionally, the study team found a quality of experience of transitional healthcare for young people with a long-term illness (diabetes) compared with those with a long-term disability. These gaps in current practice need to be addressed through service development.

Essaddam L, Kallali W, Jemel M, et al. Implementation of effective transition from pediatric to adult diabetes care: Epidemiological and clinical characteristics—a pioneering experience in North Africa. Acta Diabetologica. 2018;55(11):1163-1169. doi:10.1007/s00592-018-1196-x.

Link: https://pubmed.ncbi.nlm.nih.gov/30074090/

NPM: 12: Transition
Intervention Components (click on component to see a list of all articles that use that intervention): Planning for Transition, Pediatric to Adult Transfer Assistance, Integration into Adult Care, PROVIDER/PRACTICE, Nurse/Nurse Practitioner

Intervention Results:

This program was beneficial to 75% of patients who demonstrated an improvement in their metabolic control the year following transition to adult care service. This study is the first one in North Africa to report on the outcome of a structured transition program from pediatric to adult diabetes care. 72% of the participants in the transition process considered their experience to have been positive. The data stresses the fact that close collaboration between pediatric and adult diabetes care teams in the transition program is the key to ensure continuity of care, and results in successful transfer of adolescents to adult care, with almost 50% of young adults establishing adult care within 6 months. Overall, the study showed good attendance at transition clinic after transfer, and 67% of the patients attended three or more visits per year. A structured transition program can thus positively influence attendance post-transfer, whereas an unstructured transition with lack of communication between pediatric and adult clinics can negatively influence it. This successful implementation of a structured program for adolescents with type 1 diabetes is pioneering in Africa and appears to provide a structure for ensuring continuity of care and effective transition.

Farrell K, Fernandez R, Salamonson Y, Griffiths R, Holmes-Walker DJ. Health outcomes for youth with type 1 diabetes at 18 months and 30 months post transition from pediatric to adult care. Diabetes Research and Clinical Practice. 2018;139:163-169. doi:10.1016/j.diabres.2018.03.013

Link: https://pubmed.ncbi.nlm.nih.gov/29534994/

Intervention Results:

This study represents one of the largest and longest follow-up series of youth with diabetes after transition from pediatric to adult care and confirms the benefit of developmentally appropriate diabetes services in the adult health care setting. The key outcomes of the program were that diabetes control was maintained following transition in the 76% attending at 30-months post-transition with median frequency of visits of 3 per year, loss to follow-up rates of 8.6%, and significant reduction in DKA admissions were achieved and maintained. In the Delphi study, interval to first appointment of <6 months was considered an important benchmark for service provision in young adults with chronic disease and achieved by 95% of the cohort. Of note was the unchanged HbA1c throughout the follow-up period up to 30-months. The study demonstrates that hospital admission for DKA is preventable if youth with diabetes receive regular followup and education on sick day management. DKA admissions, readmission, and length of stay rates were significantly reduced in the first year after commencement of service and have been maintained over the period of the study. Face-to-face education on sick day management is further enhanced by a mobile phone service which allows youth with diabetes to directly contact service for sick day advice at time of crisis. In sum, continuing engagement with the multidisciplinary transition service prevented deterioration in HbA1c following transition. Age-appropriate education and regular follow-up prevents DKA admissions and significantly reduced admission LOS.

Flocco SF, Dellafiore F, Caruso R, et al. Improving health perception through a transition care model for adolescents with congenital heart disease. = Journal of Cardiovascular Medicine (Hagerstown). 2019;20(4):253-260. doi:10.2459/JCM.0000000000000770

Link: https://pubmed.ncbi.nlm.nih.gov/30676496/

NPM: 12: Transition
Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Planning for Transition, YOUTH, Peer-led Mentoring/Support Counseling, Nurse/Nurse Practitioner, PARENT/FAMILY, Counseling (Parent/Family)

Intervention Results:

The clinic showed improvement in knowledge, QOL, and overall health perception in adolescents with CHD. This model allowed for customization of the educational package, promoting patients’ communication, self-care, self-advocacy, and decision-making abilities, as well as their responsibility and self sufficiency. Improvements were greater for adolescents with simple to moderate heart disease than for those with severe CHD.

Fu N, Jacobson K, Round A, Evans K, Qian H, Bressler B. Transition clinic attendance is associated with improved beliefs and attitudes toward medicine in patients with inflammatory bowel disease. World Journal of Gastroenterology. 2017;23(29):5405-5411.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550790/

Intervention Results:

Self-reported adherence to medication rates were poor (67.4% transition, 56.8% control); adolescents in transition cohort had significantly higher belief that medications were necessary but were less skeptical (6.8% vs 20.8%) and more ambivalent (61% vs 34%) to treatment.

Geerlings RP, Aldenkamp AP, Gottmer-Welschen LM, van Staa AL, de Louw AJ. Long-term effects of a multidisciplinary transition intervention from = paediatric to adult care in patients with epilepsy. Seizure. 2016;38:46- 53. https://doi.org/10.1016/j.seizure.2016.04.004.

Link: https://pubmed.ncbi.nlm.nih.gov/27131211/

Intervention Results:

Overall, 54.5% of risk improvement could be predicted by interventions and 45.5% by patient related intrinsic factors. The improvement in the risk profile score was not statistically significant. Patient-related intrinsic factors combined are a strong predictor of improvement in medical outcome (72.7%). The transition interventions on the other hand are an equally strong predictor as patient-related factors for improvement in educational/vocational outcomes, independence, and the improvement in the overall risk score.

Hergenroeder AC, Moodie DS, Penny DJ, Wiemann CM, Sanchez-Fournier B, Moore LK, Head J. Functional classification of heart failure before and after implementing a healthcare transition program for youth and young adults transferring from a pediatric to an adult congenital heart disease clinic. Congenital Heart Disease. 2018;13(4):548-553. https://doi.org/10.1111/chd.12604.

Link: https://pubmed.ncbi.nlm.nih.gov/29542247/

NPM: 12: Transition
Intervention Components (click on component to see a list of all articles that use that intervention): Planning for Transition, Pediatric to Adult Transfer Assistance, PROVIDER/PRACTICE, EMR Reminder, Nurse/Nurse Practitioner, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide)

Intervention Results:

Intervention patients waited 13 +/-8.3 months for first adult appointment, control patients waited 26 +/-19.2 months. Control patients had a gap over three times the size of intervention patients in the difference between the recommended number of months for the follow-up appointment and the actual first adult appointment. Seven patients in the control group (23%) and no patients in the intervention group had deteriorated functional status by the time of their first adult appointment.

Huang JS, et al. Harnessing the electronic health record to distribute transition services to adolescents with inflammatory bowel disease. Journal of Pediatric Gastroenterology and Nutrition. 2020;70:200-204.

Link: https://pubmed.ncbi.nlm.nih.gov/31978017/

NPM: 12: Transition
Intervention Components (click on component to see a list of all articles that use that intervention): Planning for Transition, PROVIDER/PRACTICE, EMR Reminder

Intervention Results:

After the launch of the electronic health record (EHR) activity, 96% IBD patients 12 years and older (N=53) seen in our IBD clinic received transition preparation services. The remaining 4% (N=2) that did not receive TEA were deemed ineligible because of developmental delay. TEA recipients reported high satisfaction with, and acceptance of transition preparation services provided.

Jones MR, Robbins BW, Augustine M, Doyle J, Mack-Fogg J, Jones H, White, PH. Transfer from pediatric to adult endocrinology. Endocrine Practice. 2017;23(7):822-830. https://doi.org/10.4158/EP171753.OR.

Link: https://pubmed.ncbi.nlm.nih.gov/28534683/

Intervention Results:

Proportion of patients referred to adult practice almost tripled (11% vs 30%); proportion of patients who completed an adult visit also almost tripled (10.5% vs 27.8%). Pediatric providers continued to have discussions about the need to transfer in the year prior to the last pediatric visit (85.7% vs 87.0%); started to use transition readiness assessments (0% vs 13%); created more summaries for adult providers (52.4% vs 72.2%). Adult providers communicated back to pediatric providers at the time of the first adult visit (10.0% vs 46.0%). Attendance for referred patients at any adult visit after referral was maintained (95.2% vs 92.6%), and attendance at the visit without cancelling or failing to show was comparable (66.7% vs 70.4%). Mean patient age at time of referral and visit remained at 21 years. The gap between last pediatric and first adult visit decreased by 82 days (264 days vs 19=82 days), not statistically significant. No immediate improvement in clinical outcomes of tertiary care utilization or glycemic control were noted, nor was there evidence of significant decompensations in these measures.

Kosola S, Ylinen E, Finne P, Ronnholm K, Fernanda O. Implementation of a transition model to adult care may not be enough to improve results: National study of kidney transplant recipients. Clinical Transplantation. 2018;33(1):p. e13449-n/a. https://doi.org/10.1111/ctr.13449.

Link: https://pubmed.ncbi.nlm.nih.gov/30431669/

Intervention Results:

No significant difference was found in PS and GS rates before and after the implementation of the TM. Altogether, 114 patients (86%) completed five years of follow-up after transfer. In 63% of the cases (N = 83), KT function remained stable after transfer. In 13% (N = 17), KT function deteriorated progressively, and in 24% (N = 32), the KT lost function. The proportion of patients with stable function, deteriorating function, or graft loss, was evenly distributed in the TM and before TM cohorts.

Le Marne FA, et al. Implementing a new adolescent epilepsy service: Improving patient experience and readiness for transition. Journal of Paediatrics and Child Health 2019;55: 819-825.

Link: https://pubmed.ncbi.nlm.nih.gov/30474164/

NPM: 12: Transition
Intervention Components (click on component to see a list of all articles that use that intervention): Planning for Transition, PROVIDER/PRACTICE

Intervention Results:

The major findings of the study are that the new adolescent service was well-received by adolescents and parents, and adolescents felt their knowledge improved; however, medication adherence and transition readiness did not improve, and psychosocial supports require further modeling. There was no significant improvement in self-reported medication adherence, transition readiness, or mental well-being at follow-up.

Lemke M, Kappel R, McCarter R, D’Angelo L, Tuchman L. Perceptions of health care transition care coordination in patients with chronic illness. Pediatrics. 2018;141(5):e20173168.

Link: https://pubmed.ncbi.nlm.nih.gov/29650807/

NPM: 12: Transition
Intervention Components (click on component to see a list of all articles that use that intervention): Nurse/Nurse Practitioner, Planning for Transition, Pediatric to Adult Transfer Assistance, Care Coordination, PROVIDER/PRACTICE

Intervention Results:

Intervention participants had a Patient Assessment of Chronic Illness Care score at 12 months of 3.6 vs 3.3 compared with participants in the control group. Intervention participants had higher average scores for patient activation (3.7 vs 3.4), problem solving (3.8 vs 3.4), and coordination/ follow-up (3.0 vs 2.5). The Client Perceptions of Coordination Questionnaire revealed that intervention participants had 2.5 times increased odds to endorse mostly or always receiving the services they thought they needed and had 2.4 times increased odds to have talked to their provider about future care.

Mackie AS, Rempel G, Kovacs AH, Kaufman M, Rankin KN, Jelen S, Hons B, Yaskina M, Sananes R, Oechslin E, Dragieva D, Mustafa S, Williams E, Schuh M, Manlhiot C, Anthony S, Magill-Evans J, Nicholas D, McCrindle BW. Transition intervention for adolescents with congenital heart disease. Journal of the American College of Cardiology. 2018;71(16):1768-1777. https://doi.org/10.1016/j.jacc.2018.02.043.

Link: https://www.sciencedirect.com/science/article/pii/S0735109718333758

Intervention Results:

A total of 121 participants were randomized to receive the intervention (n = 58) or usual care (n = 63). At the recommended time of first adult appointment (excess time = 0), intervention participants were 1.8 times more likely to have their appointment within 1 month. This hazard increased with time; at an excess time of 6 months, intervention participants were 3.0 times more likely to have an appointment within 1 month. The intervention group had higher scores at 1, 6, 12, and 18 months on the MyHeart knowledge survey and the Transition Readiness Assessment Questionnaire self-management index.

Paepegaey AC, Coupaye M, Jaziri A, Menesguen F, Dubern B, Polak M, Oppert JM, Tauber M, Pinto G, Poitou C. Impact of transitional care on endocrine and anthropometric parameters in Prader-Willi syndrome. Endocrine Connections. 2018;7(5):663-672.

Link: https://pubmed.ncbi.nlm.nih.gov/29666169/

NPM: 12: Transition
Intervention Components (click on component to see a list of all articles that use that intervention): Transition Assistance, Pediatric to Adult Transfer Assistance, Integration into Adult Care, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Results:

A coordinated care pathway with specialized pediatric care and organized transition from a pediatric hospital to a Reference Center for transitioning pediatric patients with Prader-Willi syndrome (PWS) was associated with improved endocrine, metabolic, anthropometric, and psychiatric traits in adulthood. Two times more patients in the transition group had a GH stimulation test in childhood than those without transition. Only about one-third of patients in the cohort received GH treatment during childhood, but two times more patients in the transition group had GH treatment than those without transition. This difference remained significant after exclusion of patients for whom the diagnosis of PWS was received after the age of 15 years. There was a trend toward more GH stimulation test after completion of growth in patients who received GH treatment in childhood. Patients in the transition group had improved anthropometric parameters. They weighed significantly less and had a lower BMI and lower body fat, whether expressed as percentage of body weight, absolute FM, or when taking into account height (FMI). They also had a more favorable body ft repartition than patients without transition as assessed by the trunk-to-appendicular FM ratio. They also had an improved metabolic profile, as only one patient in the transition group had HBP compared to 16 without transition (P = 0.02). The percentage of type 2 diabetes was lower in the transition group, but this difference did not reach significance. Most patients of the whole cohort had behavioral or psychiatric disorders: 1/3 had a history of hospitalization in a psychiatric department during adolescence or adulthood, 2/3 displayed skin picking, half of the subjects received neuroleptics, and 1/3 had antidepressant or another psychotropic treatment. However, fewer patients in the transition group had psychiatric disorders, as fewer received antidepressants or neuroleptics. The aim of the patient survey was to obtain the perspective of patients and their families on emerging medical and social problems, particularly in adulthood. There were no significant differences depending on transition status.

Pyatak EA, Sequeira PA, Vigen CL, et al. Clinical and psychosocial outcomes of a structured transition program among young adults with type 1 diabetes. Journal of Adolescent Health. 2017;60(2):212-218. doi:10.1016/j. jadohealth.2016.09.004.

Link: https://pubmed.ncbi.nlm.nih.gov/27889401/

Intervention Results:

During the 12-month program, both groups maintained a similar frequency of routine diabetes care visits, and both groups improved their glycemic control. LC also decreased their incidence of hypoglycemia and emergency department utilization during the study period, but this group also had higher levels of depressive symptoms throughout, and their life satisfaction declined over the 12 months. The CC groups reported modest improvements in psychosocial outcomes.

Razon AN, et al. A multidisciplinary transition consult service: Patient referral characteristics. Journal of Pediatric Nursing. 2019;47:136-141.

Link: https://pubmed.ncbi.nlm.nih.gov/31129412/

NPM: 12: Transition
Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, YOUTH, Planning for Transition, Pediatric to Adult Transfer Assistance, Integration into Adult Care, Care Coordination, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Results:

At the time of this analysis, 97 (49%) referrals were seen in consultation, and 30 (15%) patients were successfully transferred to adult care. The mean time between referral and transfer to adult care was 191 days (SD=84). 24 outpatient visits were scheduled for future dates. Of note, the short-term goal of referrals was not always full transfer to adult care; out of the 42 inpatient referrals, the plan for 35 (83%) consults was to receive ongoing care from pediatric providers but with coordination assistance from the Adult Consult Team. It was estimated that transferring these initial 30 patients made 300 inpatient bed-days and over 150 outpatient appointments available for other pediatric patients in the hospital and ambulatory network.