Allan Sarah, Schmitt Jessica, Foster Christy
The University of Alabama at Birmingham, Division of Pediatric Endocrinology, 1600 7th Avenue South, Birmingham, AL 35233, United States.
Health Care Transit. 2025 Mar 9;3:100097. doi: 10.1016/j.hctj.2025.100097. eCollection 2025.
Adolescence can be defined as the period during which all individuals move from childhood to adulthood, including in the healthcare system, creating a need for a healthcare transition process. Children's of Alabama provides four transition education sessions during clinic visits for adolescents with type 1 diabetes (T1D). We aimed to assess baseline patient data and patient perspectives of our current transition education process to guide our efforts to improve this process.
We used a mixed methods design comprised of a quantitative analysis of baseline data in our adolescents with T1D and qualitative analysis of provide and patient perspectives. We queried the electronic medical record to obtain baseline characteristics of adolescent adolescents with T1D seen at our center from January 2022 to May 2022 and sought input via anonymous surveys of adult and pediatric endocrinology attendings, fellows, and nurse practitioners at our institution and of adolescents with T1D who had completed the final education session via an electronic secure database.
Electronic Medical review of adolescents with T1D transitioning to adult care at our center revealed most of our adolescents with T1D had a gap in care of four months or greater between last pediatric visit and first adult visit. Pediatric provider surveys emphasized barriers for adolescents with T1D with appointment scheduling and challenges navigating the adult health care system. Adult surveys emphasized lack of communication with the adult health care team. Adolescents with T1D overall reported transition education prepared them well for adult care, but only 35.3 % had identified an adult provider after completing transition education.
Our findings outline additional areas for improvement in our transition process for adolescents with T1D. Based on feedback from the pediatric team, we are working to initiate transition education by age 16, standardize document discussions around transition, document date of planned transition, and document planned accepting adult provider. We are working to streamline record transfer based on feedback from adult providers. Based on patient feedback and our documented gaps in care, we are working to place referrals for adult care to minimize gaps in diabetes care.
青春期可定义为所有人从儿童期步入成年期的阶段，在医疗保健系统中亦是如此，这就产生了医疗保健过渡过程的需求。阿拉巴马州儿童医院在为1型糖尿病（T1D）青少年患者进行门诊时提供四次过渡教育课程。我们旨在评估基线患者数据以及患者对当前过渡教育过程的看法，以指导我们改进这一过程的工作。
我们采用了混合方法设计，包括对T1D青少年患者的基线数据进行定量分析，以及对提供者和患者的看法进行定性分析。我们查询了电子病历，以获取2022年1月至2022年5月在我们中心就诊的T1D青少年患者的基线特征，并通过对我们机构的成人及儿科内分泌科主治医师、住院医师和执业护士，以及通过电子安全数据库完成最后一次教育课程的T1D青少年患者进行匿名调查来征求意见。
对在我们中心向成人护理过渡的T1D青少年患者的电子病历审查显示，大多数T1D青少年患者在最后一次儿科就诊和首次成人就诊之间存在四个月或更长时间的护理间隔。儿科提供者调查强调了T1D青少年患者在预约安排方面的障碍以及在成人医疗保健系统中导航的挑战。成人调查强调了与成人医疗保健团队缺乏沟通。总体而言，T1D青少年患者报告称过渡教育使他们为成人护理做好了充分准备，但只有35.3%的患者在完成过渡教育后确定了成人提供者。
我们的研究结果概述了T1D青少年患者过渡过程中需要改进的其他领域。根据儿科团队的反馈意见，我们正努力在16岁时启动过渡教育，规范围绕过渡的文件讨论，记录计划过渡日期，并记录计划接受的成人提供者。我们正根据成人提供者的反馈意见努力简化记录转移。根据患者反馈以及我们记录的护理差距，我们正努力安排成人护理转诊，以尽量减少糖尿病护理方面的差距。
