Baylor College of Medicine, Division of Adolescent Medicine and Sports Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Kleck School of Medicine of the University of Southern California, University Park Campus, Los Angeles, California.
J Adolesc Health. 2022 Jul;71(1):105-111. doi: 10.1016/j.jadohealth.2022.01.226. Epub 2022 Mar 26.
Poorly planned healthcare transition (HCT) from pediatric to adult-based care for adolescents and young adults with special healthcare needs (AYASHCN) is associated with increased morbidity and mortality. Most pediatricians and pediatric residents are not trained to assist AYASHCN with HCT planning. An electronic medical record-based Transition Planning Tool (TPT) was developed at a large children's hospital to guide provider-patient interactions around HCT planning. The purpose of this study was to evaluate an educational intervention to promote residents' use of the TPT.
A multimodal (TPT training, demonstrations, use prompts, and case discussions) curriculum promoting the use of the TPT was developed and implemented within a one-month Adolescent Medicine Rotation. A prospective, nonrandomized, quasi-experimental design with Intervention and Historical Control groups was used. Forty-two residents received the intervention. Twenty-three Historical Control residents received minimal formal training in the TPT. Intervention Group residents completed prerotation/postrotation assessments measuring perceived importance of/comfort with HCT planning and self-reported HCT planning activities. TPT use was compared between the two groups.
Compared to the Historical Control Group, Intervention Group residents were significantly more likely to use the TPT (98% vs. 37%, p < .001) and had a higher mean number of uses (5.5 ± 3.0 vs. 2.6 ± 1.2, p < .001). Residents reported greater perceived importance of (p < .001) and engagement in (p < .001) transition planning activities after completing the intervention. Nearly all (91%) reported that their training increased their comfort in HCT planning.
A targeted intervention improved pediatric residents' use of the TPT and HCT planning activities.
对于有特殊医疗需求的青少年和年轻人（AYASHCN），如果医疗过渡（HCT）计划不完善，从儿科向成人基础护理过渡，会导致发病率和死亡率增加。大多数儿科医生和住院医师都没有接受过协助 AYASHCN 进行 HCT 规划的培训。一家大型儿童医院开发了一种基于电子病历的过渡规划工具（TPT），用于指导医疗服务提供者与患者就 HCT 规划进行互动。本研究的目的是评估一项促进住院医师使用 TPT 的教育干预措施。
开发了一种多模式（TPT 培训、演示、使用提示和案例讨论）课程，以促进 TPT 的使用，并在为期一个月的青少年医学轮转中实施。采用干预和历史对照的前瞻性、非随机、准实验设计。42 名住院医师接受了干预措施。23 名历史对照住院医师接受了 TPT 的最低程度的正规培训。干预组的住院医师在轮岗前和轮后完成了评估，以衡量他们对 HCT 规划的重要性和舒适度以及自我报告的 HCT 规划活动。比较了两组之间的 TPT 使用情况。
与历史对照组相比，干预组住院医师使用 TPT 的可能性显著更高（98%比 37%，p <.001），使用次数也更高（平均 5.5 ± 3.0 次比 2.6 ± 1.2 次，p <.001）。住院医师报告称，在完成干预措施后，他们对过渡规划活动的重要性（p <.001）和参与度（p <.001）的看法有了显著提高。几乎所有（91%）的住院医师都表示，他们的培训增加了他们在 HCT 规划方面的舒适度。
有针对性的干预措施提高了儿科住院医师对 TPT 和 HCT 规划活动的使用。
