161 - Improving the Use of Transition Readiness Assessment Questionnaire (TRAQ) in our General Academic Pediatric (GAP) Practice

Publication Number: 3155.161

Sarah Mohiuddin, Eastern Virginia Medical School, Norfolk, VA, United States; Elizabeth Harvie, Eastern Virginia Medical School, Norfolk, VA, United States; Lindsey Hill, Eastern Virginia Medical School, Norfolk, VA, United States; John W. Harrington, Children's Hospital of The King’s Daughters, Norfolk, VA, United States

Background: Transition from pediatric to adult healthcare is critical, yet often difficult to initiate and prioritize in a busy practice. The Transition Readiness Assessment Questionnaire (TRAQ) is a validated tool that assesses an adolescent's preparedness for transition. Despite its value, integration into standard care is limited due to time constraints and perceptions of low clinical utility. In early 2025, TRAQ was piloted among a small cohort of autistic patients in the Children's Hospital of The King's Daughters (CHKD) General Academic Pediatric (GAP) practice, revealing widespread low readiness scores. This project aimed to improve TRAQ utilization and incorporate it into standard workflow for all well-child visits for patients aged 15 and older.

Objective: To implement and evaluate a modified, clinic-friendly version of the TRAQ ("fast-TRAQ") in order to improve transition readiness screening rates and identify skill gaps among adolescents and young adults in a general pediatric practice.

Design/Methods: Several Plan-Do-Study-Act (PDSA) cycles were implemented. A shortened version of the TRAQ ("fast-TRAQ") using only the second half of the questionnaire was created. Providers were educated on TRAQ's purpose, and the form was embedded into pre-visit paperwork. Patients aged 15+ completed forms in the waiting room, and responses were manually entered into the electronic medical record (EMR) by nurses or attendings. Scores were analyzed weekly, with averages calculated by domain and patient age. The administration rate was monitored over eight weeks, excluding patients with developmental limitations.

Results: Embedding fast-TRAQ into pre-visit paperwork significantly increased completion. Provider education and improved documentation in EMR were essential to sustaining these gains. Age-stratified TRAQ data showed a bell curve distribution: lowest scores in 15-year-olds, peaking in 17-18-year-olds, and declining in 20-year-old. A subset of forms were incomplete, suggesting continued barriers to the process.

Conclusion(s): Modifying the TRAQ process and embedding it into clinic workflow improved utilization without burdening staff. Preliminary results highlight critical skill gaps that can guide patient education. The declining score in young adults may reflect increased complexity or support needs in older patients still seen in pediatric care. Next steps include administering the full TRAQ to patients scoring ≥3 on fast-TRAQ and expanding use to sick visits. We aim to continue data collection to support standardized, efficient, and patient-centered transition planning in the GAP practice.

Letter of Enrollment Verification
Letter of enrollment verification for S. Mohiuddin for AAD - Jan 2025.pdf

Overall TRAQ Score vs. Age
Overall TRAQ score by Age. Age groups 15, 16, 17, 18, 19, and 20 years consisted of 18, 12, 13, 18, 3, and 4 patients, respectively.

"Importance" and "Ability" Regarding Transition by Age Group
Average by age group of feelings of how important transition is vs how confident an adolescent feels in their ability to transition.