This proposal seeks to improve transition care using health information technology. The process of transition from a pediatric to adult provider is a universal need across both primary care and subspecialties. Little work has been done specifically within pediatric gastroenterology to address the needs of patients with chronic gastrointestinal disease. We propose to use an existing computerized clinical decision support system (CHICA ? the Child Health Improvement through Computer Automation system) to pilot a youth-to-adult Transition module within a large primary care network. This will be accomplished by automating the ?Six Core Elements of Healthcare Transition? set forth by the National Health Care Transition Center. These core elements consist of: (1) sharing the transition policy with families, (2) providing transition tracking and monitoring, (3) assessing transition readiness using a standardized tool (the TRAQ ? Transition Readiness Assessment Questionnaire), (4) transition planning through iterative preparation of all necessary transition skills and documents, (5) accomplishing the transfer of care itself, and (6) assessing transfer completion. Each of these core elements will be accomplished using a combination of patient-facing (tablets) and provider-facing (webforms alongside the electronic medical record). Once these software rules are written and tested, they will be piloted in the existing primary care decision support system. We will iteratively assess the following goals: (1) each patient?s transition readiness as appropriate for their age, and (2) provider and patient satisfaction with the transition process. These outcomes will be compared in a pre-post design, data will be collected during the first 6 months prior to the Transition module being implemented in CHICA. Following this 6-month period, the Transition module will be turned on, and a repeat assessment made of these outcomes. If this pilot test is successful, we will then be ready to launch this module in a similar system (CHICA-GI) that will be live in the pediatric gastroenterology clinic. Once this system has a transition module active, we will be able to test if it accomplishes similar goals for gastroenterology subspecialty patients, including disease-specific transition goals, in future R21 and R01 applications. Overall, the proposed R03 represents a stepwise set of activities which will expand upon the groundwork laid in my K-award application regarding the exploration of whether adherence to guidelines or recommended care practices can be improved through the use of computerized decision support systems, and thereby ultimately impact health and patient-centered outcomes. Given my past experience of implementing a primary care CDSS (K-award Aim 1) and my current experience implementing a gastroenterology-specific CDSS (K-award Aims 2 and 3), the R03 fits seamlessly with my current activities. This award will allow for another dimension to be added to the existing system on both the primary care and gastroenterology side.
Transitioning from pediatric to adult care providers is a significant goal for all patients, but especially patients with complex health care problems and special needs. Health information technology is an important way to accomplish this critical long term goal for children in all health care settings, including subspecialties. We will adapt an existing computerized system to help automate the process of pediatric-to-adult care transition in primary care offices, and then use the lessons learned from this approach in the pediatric gastroenterology clinic.
