U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service at the Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Pediatr Transplant. 2021 Mar;25(2):e13839. doi: 10.1111/petr.13839. Epub 2020 Sep 30.
The Six Core Elements of Transition have been advocated to guide transition, but little is published about their use with liver transplant patients. We started a liver transplant transition program in August 2015 using quality improvement (QI) methods and by linking the Six Core Elements of Transition to process measures. Eligible patients completed baseline transition readiness assessments (Readiness for Transition Questionnaire, RTQ), interviews with a psychologist, received focused education, and completed follow-up RTQs before transfer to adult care. Our QI goal was to improve RTQ scores by 20% prior to transfer to adult care. We also assessed continuity of care, tacrolimus levels, rejection, and retransplantation as balancing measures. Of the 24 patients who completed the transition program and were transferred to adult care, RTQ scores were available for 11 patients. Overall RTQ scores improved from 23.7 to 30.5 (+28.7%, P = .009) prior to transfer. Nearly two-thirds (63%) of patients were seen by adult transplant hepatology within 6 months, and one patient was lost to follow-up after the first adult visit. Tacrolimus-level standard deviations were <2.0 in 45% of patients in pediatric care and 72% of patients in adult care. Three patients had undergone immunosuppression withdrawal in pediatric care, with one restarted on immunosuppression prior to transfer to adult care due to late acute rejection. The Six Core Elements of Transition can be translated into patient- and system-level transition milestones to serve as potential quality metrics in the implementation of transition programs.
过渡的六个核心要素被提倡用于指导过渡，但很少有关于将其用于肝移植患者的报道。我们于 2015 年 8 月开始使用质量改进 (QI) 方法和将过渡的六个核心要素与流程措施联系起来的方法，开展肝移植过渡项目。符合条件的患者在转至成人护理前完成过渡准备情况评估（过渡准备问卷，RTQ）、与心理学家面谈、接受重点教育并完成后续 RTQ。我们的 QI 目标是在转至成人护理前将 RTQ 评分提高 20%。我们还评估了连续性护理、他克莫司水平、排斥反应和再次移植作为平衡措施。在完成过渡项目并转至成人护理的 24 名患者中，有 11 名患者的 RTQ 评分可用。总体 RTQ 评分从 23.7 提高到 30.5（增加 28.7%，P =.009），在转至成人护理前。近三分之二（63%）的患者在 6 个月内接受成人移植肝病学的就诊，1 名患者在首次成人就诊后失去随访。在儿科护理中，45%的患者他克莫司水平标准差<2.0，而在成人护理中，72%的患者他克莫司水平标准差<2.0。在儿科护理中有 3 名患者停止免疫抑制治疗，其中 1 名患者在转至成人护理前因晚期急性排斥反应重新开始免疫抑制治疗。过渡的六个核心要素可以转化为患者和系统层面的过渡里程碑，作为过渡项目实施的潜在质量指标。
