University of Rochester Medical Center, Department of General Pediatrics, NY, United States of America.
Center for Autism and Developmental Disabilities, Henry Ford Medical Center, United States of America.
J Pediatr Nurs. 2019 Jul-Aug;47:44-50. doi: 10.1016/j.pedn.2019.04.007. Epub 2019 Apr 28.
Youth and young adults require systematic planning, transfer and integration into adult healthcare. A national health care transition (HCT) learning network (LN) shared strategies during monthly calls to improve HCTs using Got Transition™'s Six Core Elements. Among LN participants, we conducted a pre-post mixed-methods evaluation of this evidence-informed process improvement framework.
Leaders from seven health systems in the LN recruited 55 participating practice sites (12 primary care, 43 specialty care, 47 pediatric care, and 8 adult care). Got Transition's Current Assessment (CA) of HCT Activities (possible score: 0-32) assessed implementation of HCT process improvements in all 55 sites at baseline (2015-2017) and again after 12-18 months. Pre-post results were compared overall and by type of practice (primary vs. specialty, pediatric vs. adult). In early 2018, health system leaders qualitatively described factors impacting HCT process implementation.
Overall, baseline CA scores averaged 10.7, and increased to 17.9 after 12-18 months. Within each clinical setting, scores increased from: 10.8 to 16.5 among 12 primary care sites, 12.8 to 17.1 among 43 specialty sites, 12.4 to 17 among 47 pediatric sites, and 12 to 16.9 among 8 adult sites. All changes reached significance (p < 0.05). Qualitative feedback offered valuable feedback about motivators, facilitators and barriers to HCT process improvement.
Participating systems made substantial progress in implementing a structured HCT process consistent with clinical recommendations using the Six Core Elements.
The diverse perspectives of participating health systems provide a model for creating sustainable HCT process improvements.
青年人和年轻人需要系统的规划、转移和整合到成人保健中。一个国家卫生保健过渡（HCT）学习网络（LN）通过每月的电话会议分享策略，使用 Got Transition 的六个核心要素来改善 HCT。在 LN 参与者中，我们对这一循证过程改进框架进行了前后混合方法评估。
LN 中的 7 个卫生系统的领导人从 55 个参与的实践站点（12 个初级保健、43 个专科保健、47 个儿科保健和 8 个成人保健）中招募。Got Transition 的 HCT 活动当前评估（CA）（可能得分：0-32）在所有 55 个站点的基线（2015-2017 年）和 12-18 个月后再次评估 HCT 过程改进的实施情况。前后结果进行了总体比较，并按实践类型（初级保健与专科保健、儿科保健与成人保健）进行了比较。在 2018 年初，卫生系统领导人定性描述了影响 HCT 过程实施的因素。
总体而言，基线 CA 得分平均为 10.7，在 12-18 个月后增加到 17.9。在每个临床环境中，得分从以下方面增加：12 个初级保健站点从 10.8 增加到 16.5，43 个专科站点从 12.8 增加到 17.1，47 个儿科站点从 12.4 增加到 17，8 个成人站点从 12 增加到 16.9。所有变化均具有统计学意义（p<0.05）。定性反馈提供了关于 HCT 过程改进的动机、促进因素和障碍的有价值的反馈。
参与系统在实施与临床建议一致的结构化 HCT 过程方面取得了重大进展，使用了六个核心要素。
参与卫生系统的多样化观点为创造可持续的 HCT 过程改进提供了模型。
