Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Mass; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Brigham and Women's Faulkner Hospital, Mass.
Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Mass; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Brigham and Women's Faulkner Hospital, Mass.
Acad Pediatr. 2018 Jan-Feb;18(1):111-118. doi: 10.1016/j.acap.2017.04.005. Epub 2017 Apr 18.
Youth with special health care needs (YSHCN) require assistance from their pediatricians to transition to adult care. There are few data on what transition resources pediatricians have. In this article we discuss whether care coordination and/or comprehensive electronic health record (CEHR) implementation are associated with improved transition processes.
Using the American Academy of Pediatrics Periodic Survey #79, we report whether practices generated written transition plans, assisted in finding adult providers, and discussed confidentiality issues. Descriptive statistics and a logistic regression model were done to evaluate whether CEHR, care coordination, or practice and physician characteristics were associated with improved transition planning.
Transition planning support in practices is low. Pediatricians with any care coordinator report more written transition plans for YSHCN (23% vs 6%; P < .001), assistance identifying adult providers (59% vs 39%; P < .001), and discussing confidentiality issues (50% vs 33%; P < .001). Pediatricians with a CEHR compared with those without are more likely to report written transition plans for YSHCN (24% vs 12%; P < .05) and discussing confidentiality issues (51% vs 39%; P < .05). In the logistic regression model, having care coordination (adjusted odds ratio, 11.1; 95% confidence interval, 5.9-21.3) and CEHR (adjusted odds ratio, 2.6; 95% confidence interval, 1.5-5.0) were independently associated with higher odds of having a written transition plan.
Only 1 in 5 pediatricians have a transition coordinator in their practice and just 15% have a CEHR, even as these resources are associated with improved transition processes for YSHCN. Policy decisions should be made to help practices with supports, such as care coordination and electronic health record implementation, to improve transitions to adulthood.
有特殊医疗需求的青年（YSHCN）需要儿科医生的帮助才能过渡到成人护理。关于儿科医生拥有哪些过渡资源的数据很少。在本文中，我们讨论了护理协调和/或综合电子健康记录（CEHR）的实施是否与改善过渡过程有关。
使用美国儿科学会定期调查#79，我们报告实践中是否生成了书面过渡计划，协助寻找成人提供者，并讨论了保密性问题。采用描述性统计和逻辑回归模型来评估 CEHR、护理协调或实践和医生特征是否与改善过渡计划有关。
实践中的过渡计划支持率较低。有任何护理协调员的儿科医生报告为 YSHCN 制定了更多书面过渡计划（23%比 6%；P<0.001），协助确定成人提供者（59%比 39%；P<0.001），并讨论保密性问题（50%比 33%；P<0.001）。与没有 CEHR 的儿科医生相比，拥有 CEHR 的儿科医生更有可能为 YSHCN 报告书面过渡计划（24%比 12%；P<0.05）和讨论保密性问题（51%比 39%；P<0.05）。在逻辑回归模型中，护理协调（调整优势比，11.1；95%置信区间，5.9-21.3）和 CEHR（调整优势比，2.6；95%置信区间，1.5-5.0）与书面过渡计划的可能性增加独立相关。
只有 1/5 的儿科医生在其实践中有过渡协调员，只有 15%的儿科医生有 CEHR，尽管这些资源与 YSHCN 的过渡过程改善有关。应该做出政策决策，为实践提供支持，例如护理协调和电子健康记录的实施，以改善向成年期的过渡。
