35 - A program promoting successful transition to adult healthcare for underinsured adolescents and young adults with special health care needs

Publication Number: 3032.35

Connie Wiemann, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States; Julie Harmon, Baylor College of Medicine, Mo. City, TX, United States; Jordyn Babla, Baylor College of Medicine/ Texas Children’s Hospital, Murphy, TX, United States; Blanca Sanchez-Fournier, Baylor College Medicine, Houston, TX, United States; Sahar Siddiqui, Baylor College of Medicine, Houston, TX, United States; Titilope Fasipe, Baylor College of Medicine, Houston, TX, United States; Albert C. Hergenroeder, Baylor College of Medicine, Houston, TX, United States

Background: Uninsured or publicly insured adolescents and young adults with special health care needs (AYA) experience increased morbidity/mortality during transition from pediatric to adult-based care.

Objective: A 3-year quality improvement (QI) initiative to improve access to adult primary and specialty care for AYA transitioning from a large children’s hospital to a county hospital system.

Design/Methods: Barriers/facilitators to effective healthcare transition for AYA with renal and sickle cell diseases (SCD) were identified through key stakeholder interviews, baseline data, and QI tools (e.g., Fishbone diagram). Two aims guided the project: by May 2024, 1) 90% of AYA will attend a PCP appointment within 30 days of being approved for services, and 2) 90% of AYA referred to a specialist will attend appointments within 5 months. New structures and processes were introduced via Plan-Do-Study-ACT (PDSA) cycles. For example: bi-weekly meetings with key stakeholders (county hospital system, city Health Department, pediatric and adult providers, patient navigators); partnership with city Health Department eligibility office to expedite financial assistance approvals; refined referral criteria between pediatric and adult specialists; and patient navigators to support AYA in scheduling/attending appointments. Metrics were: number of AYA approved for adult services; percentage of AYA attending PCP and specialist appointments within target timeframes; and stakeholder satisfaction. Referrals were intentionally paced to avoid overwhelming adult provider capacity.

Results: 124 AYA (100 renal, and 24 SCD) were eligible for county health services; 88 were approved; 88 PCP appointments were made; 79 were attended the first time (n=64) or after rescheduling (n=15). Fifty-two specialist appointments were made; 44 were attended the first time (n=34) or after rescheduling (n=10). Overall, 60% of AYA attended a PCP appointment within 30 days of being approved for county services (bi-monthly range: 40-100%). Likewise, 76% of AYA referred to a specialist attended appointments within 5 months (range: 0-100%). Stakeholders were highly satisfied with transition processes/services.

Conclusion(s): Although further quality work is needed to achieve our aims, this project demonstrated that successful transition to primary and subspecialty adult care for AYA aging out of Medicaid is attainable through structured processes and collaborative systems. Effective strategies included monthly working meetings with all key stakeholders, weekly conversation/coordination between pediatric and adult staff, and flexible communication methods to engage AYA.

Fig. Fishbone Diagram: barriers to accessing adult care for patients transitioning out of pediatric care
Fig. Fishbone diagram.pdf