Abstract
BackgroundTransition from pediatric to adult health care is a vulnerable period for adolescents and young adults. Challenges include paucity of validated measures to assess patients’ transition readiness. We evaluated the Transition Readiness Assessment Questionnaire (TRAQ) in adolescents and young adults with rheumatic, gastrointestinal, and endocrine disorders. We examined whether baseline TRAQ scores and other demographic variables predicted transition to adult care over a three year follow up period.MethodsIn this descriptive study at a single institution, eighty-nine adolescents at a single pediatric academic medical center completed demographic and medical history surveys and the TRAQ and were followed over 3 years by telephone interview to determine whether they had transitioned to adult subspecialty care. Transition was defined as attending at least one adult subspecialty appointment. Multivariable logistic regression and Cox proportional hazards regression models were used to determine whether TRAQ scores predicted time to transition.ResultsOf the participants, 56% had rheumatic, 21% endocrine, and 23% gastrointestinal conditions. The TRAQ self-management domain score was not significantly associated with age, gender, socioeconomic status, or specialty. The TRAQ self-advocacy score increased with age. Baseline TRAQ scores did not predict transition or time to transition over three years.ConclusionIn this cohort of adolescents and young adults who were 16 to 23 years of age at enrollment, 48% transitioned to adult care over three years of follow up. Nearly half reported not discussing transition with provider or seeing provider independently for part of visit. Older age but not other demographic variables nor baseline TRAQ score predicted transition or time to transition to an adult subspecialty provider; however, a there was a trend towards shorter time to transition with the highest quartile TRAQ scores.
Highlights
Transition from pediatric to adult health care is a vulnerable period for adolescents and young adults
Health Care Needs (NS-CSHCN) found that only 15% of youth reported that their doctor had discussed changing needs in adulthood, including the need to transition to an adult doctor [16]
We aimed to evaluate whether demographic variables or baseline Transition Readiness Assessment Questionnaire (TRAQ) scores predicted transition or time to transition over 3 years in a cohort of adolescents and young adults with rheumatic, endocrine, and gastrointestinal (GI) disorders
Summary
Transition from pediatric to adult health care is a vulnerable period for adolescents and young adults. In the United States, approximately 500,000 adolescents with special health care needs reach the age of 18 each year and need to transition from pediatric to adult health care [1]. Health Care Needs (NS-CSHCN) found that only 15% of youth reported that their doctor had discussed changing needs in adulthood, including the need to transition to an adult doctor [16]. A 2006 follow up NS-CSHCN survey identified that only 40% of youth reported meeting the medical transition outcome measure (a composite of whether the provider had discussed transition to adult care, health care needs, health insurance, and had encouraged the patient to take responsibility for his/her own care) [1, 6]. The Agency for Health Care Research and Quality (AHRQ) has acknowledged that identification of optimal transition processes and interventions are limited by the lack of a robust evidence base [18]
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