Siddiqui Sahar, Zimmerman Cortney Taylor, Garza Brittany, Saridey Sai Kaumudi, Wiemann Constance M
Baylor College of Medicine/Texas Children's Hospital, Department of Pediatrics, Division of Nephrology, 1102 Bates Ave., Ste. 245, Houston, TX 77030, USA.
Baylor College of Medicine/Texas Children's Hospital, Department of Pediatrics, Divisions of Psychology and Nephrology, 1102 Bates Ave., Ste. 245, Houston, TX 77030, USA.
Health Care Transit. 2023 Aug 24;1:100014. doi: 10.1016/j.hctj.2023.100014. eCollection 2023.
The transition from pediatric to adult health care is challenging for patients with renal disease and inadequate transition can lead to increased disease-related morbidity. We developed a structured health care transition (HCT) program that includes a joint two-step transition clinic; the first step is the pediatric clinic and second step is the adult clinic.
Quality improvement methodology was utilized to establish an interdisciplinary transition team and conduct a needs assessment. Lack of a standardized HCT program was identified as a primary barrier to HCT. We utilized transition team and other stakeholder input to implement a transition program that included a joint pediatric/adult two-step transition clinic. Various other components were developed, including a transition policy and patient and provider feedback surveys. A pilot group of patients with kidney disease participated in the program.
27 patients completed the "first step" and 22 patients completed the "second step" of the transition clinic. Median age at the time of transition was 20 years, with kidney transplant (41 %) as the major diagnosis. All patients (100 %) received the transition policy and reported that the transition team worked with them to gain skills to manage their health and plan for the future. Pediatric and adult nephrologists reported feeling satisfied (100 %) with the transition program.
A structured transition program was established utilizing expertise of a dedicated transition team and was well received by participants. This program is a critical first step in addressing the gap in standardized care for transition for pediatric patients with kidney disease.
对于肾病患者而言，从儿科医疗向成人医疗的过渡颇具挑战，过渡不当会导致与疾病相关的发病率上升。我们制定了一项结构化的医疗保健过渡（HCT）计划，其中包括一个联合两步过渡诊所；第一步是儿科诊所，第二步是成人诊所。
运用质量改进方法组建了一个跨学科过渡团队并进行了需求评估。缺乏标准化的HCT计划被确定为HCT的主要障碍。我们利用过渡团队和其他利益相关者的意见实施了一项过渡计划，该计划包括一个联合儿科/成人两步过渡诊所。还制定了各种其他组成部分，包括一项过渡政策以及患者和提供者反馈调查。一组肾病患者试点参与了该计划。
27名患者完成了过渡诊所的“第一步”，22名患者完成了“第二步”。过渡时的中位年龄为20岁，主要诊断为肾移植（41%）。所有患者（100%）都收到了过渡政策，并表示过渡团队与他们合作，帮助他们获得管理自身健康和规划未来的技能。儿科和成人肾病专家对过渡计划表示满意（100%）。
利用一个专门过渡团队的专业知识建立了一个结构化的过渡计划，并受到了参与者的好评。该计划是解决肾病儿科患者过渡标准化护理差距的关键第一步。
