Transition Of Young Adults Research Articles

The Transition to Adulthood: A Qualitative Study of Autism Spectrum Disorder From Military and Veteran Parents and Military-Dependent Young Adults.

Given the unique experiences of military service members and their families, military-dependent young adults (18-25 years old) with autism spectrum disorder (ASD) and their military or veteran families experience unique barriers to accessing quality mental health care during the transition to adulthood. In fact, developing services to address ASD challenges for military families is a burgeoning area of interest for the department of defense. However, there is a limited knowledge on the specific needs of military families as the young adult's transition outside of high school and lose supports. The present study conducted 3 focus groups with 16 military and veteran parents, and 3 focus groups with 10 military-dependent young adults to evaluate the needs of military-dependent young adults (17-25 years old) with ASD and military/veteran parents with a young adult with ASD. Parents reported several key topics, including barriers to services (e.g., permanent change of station, recently moving to a state and lacking awareness of the available resources), defining adulthood in terms working in a cohesive family structure, and therapy recommendations for parents and young adults with ASD transitioning to adulthood. Young adults provided key information, including describing experiences with having a parent in the military, difficulty accessing services during the transition to adulthood, and recommendations on therapy for military-dependent young adults with ASD. Military and veteran families with autistic dependents lack access to important mental-health resources. When developing programs for military families and military-dependent autistic young adults, mental health providers should consider the frequent relocations, lack of access to important transition resources, and common military values. The presence of advocates at military bases should be encouraged to help military families navigate autism services in their local community.

Optimising healthcare transition of adolescents and young adults to adult care: a perspective statement of the Italian Society of Obesity

The transition to adult health care (HCT, Health Care Transition), is the purposeful, planned movement of patients from paediatric to adult services. For the adolescent living with obesity (ALwO), the HCT represents a crucial window for effective intervention that can help improve body weight, adiposopathy, and metabolic complications. Nevertheless, no transition guidelines, models, and tools have been developed for these patients. The present statement of the Italian Society of Obesity examines the critical transition of ALwO from paediatric to adult healthcare. It synthesises current knowledge and identifies gaps in HCT of ALwO. Drawing on successful practices and evidence-based interventions worldwide, the paper explores challenges, including disparities and barriers, while advocating for patient and family involvement. Additionally, it discusses barriers and perspectives within the Italian health care scenario. The need for specialised training for healthcare providers and the impact of transition on healthcare policies are also addressed. The conclusions underscore the significance of well-managed transitions. The SIO recognises that without proper support during this transition, ALwOs risk facing a gap in healthcare delivery, exacerbating their condition, and increasing the likelihood of complications. Addressing this gap requires concerted efforts to develop effective transition models, enhance healthcare provider awareness, and ensure equitable access to care for all individuals affected by obesity. The document concludes by outlining avenues for future research and improvement.

Resource use and costs of transitioning from paediatric to adult care for patients with chronic endocrine disease.

Structured transition of adolescents and young adults with a chronic endocrine disease from paediatric to adult care is important. Until now, no data on time and resources required for the necessary components of the transition process and the associated costs are available. In a prospective cohort study of 147 patients with chronic endocrinopathies, for the key elements of a structured transition pathway including (i) assessment of patients' disease-related knowledge and needs, (ii) required education and counselling sessions, (iii) compiling an epicrisis and a transfer appointment of the patient together with the current paediatric and the future adult endocrinologist resource consumption and costs were determined. One hundred and forty-three of 147 enroled patients (97.3%) completed the transition pathway and were transferred to adult care. The mean time from the decision to start the transition process to the final transfer consultation was 399 ± 159 days. Transfer consultations were performed in 143 patients, including 128 patients jointly with the future adult endocrinologist. Most consultations were performed by a multidisciplinary team consisting of a paediatric and adult endocrinologist, psychologist, nurse, and a social worker acting also as a case manager with a median of three team members and lasted 87.6 ± 23.7 min. The mean cumulative costs per patient of all key elements were 519 ± 206 Euros. In addition, costs for case management through the transition process were 104.8 ± 28.0 Euros. Using chronic endocrine diseases as an example, it shows how to calculate the time and cost of a structured transition pathway from paediatric to adult care, which can serve as a starting point for sustainable funding for other chronic rare diseases.

Predictors of successful transition of adolescents and young adults living with HIV from pediatric to adult-oriented care in southern Ethiopia: a retrospective cohort study

BackgroundThe introduction of highly active antiretroviral therapy has significantly improved the life expectancies of children and adolescents living with HIV, leading to an increased number transitioning to adult care. However, there has been a lack of studies in Ethiopia focusing on factors influencing the success of this transition. Therefore, this study aimed to determine predictors of a successful transition from pediatric to adult HIV clinics among adolescents and young adults living with HIV in health facilities in southern Ethiopia.MethodsA retrospective cohort study included 337 adolescents and young adults who transitioned to adult-oriented HIV care. Successful transition was defined as having a viral load of less than 1000 copies/ml and maintaining care during the first year post-transition. Patients’ antiretroviral therapy (ART) cards and monitoring charts were reviewed. Secondary data analysis was conducted using a multivariable binary logistic regression model to identify predictors of a successful transition. Using the variance inflation factor, we checked for multi-collinearity between variables and assessed model fitness with the Hosmer and Lemeshow goodness-of-fit test. Adjusted Odds Ratio (AOR) with 95% confidence intervals (CI) and P-value ≤ 0.05 measured the strength of association and statistical significance.ResultsOf 337 participants, 230 (68.25%) successfully transitioned (95% CI = 63.25, 73.25). Transitioning at age 18 or older (AOR = 4.25; 95% CI = 2.29, 7.87), residing in an urban area (AOR = 1.78; 95% CI = 1.04, 3.02), and being on antiretroviral therapy for more than two years (AOR = 4.25; 95% CI = 1.17, 4.94; P < 0.017) were identified as positive predictors and opportunistic infection (AOR = 0.34; 95% CI = 0.15, 0.75; P < 0.008) was identified as a negative predictor for a successful transition from pediatric to adult ART clinic.ConclusionThis study sheds light on the challenges faced by HIV patients transitioning from pediatric to adult care, with less than 70% successfully navigating this critical phase. Factors such as age at transition, residence, duration of ART, and the presence of opportunistic infections were identified as key predictors of successful transition. The findings underscore the urgent need for tailored interventions, including standardized transition plans that address age and urban/rural disparities, to enhance transition outcomes for adolescents and young adults living with HIV in the region.

The Occupational Therapy Vocational Profile (OTVP): Supporting transition and employment opportunities for young adults with disabilities

ABSTRACT Transition to adulthood can be challenging for individuals with intellectual and developmental disabilities (IDD), with and without concurrent mental health conditions. Research shows that young adults with disabilities face a variety of barriers and are more likely to be unemployed than those without a disability. Occupational therapy practitioners (OTPs) can play an integral role in supporting young adults as they transition out of school and into supported or competitive employment. The Occupational Therapy Vocational Profile (OTVP) was developed to support young adults with IDD, with or without concurrent mental health conditions, as they leave school and transition to adulthood. The OTVP is a non-standardized, comprehensive evaluation tool that consists of three subtests based on the Person-Environment-Occupation (PEO) Model. It includes a summary of results that provides a description of an individual’s goals, interests, strengths, needs, and recommended vocational accommodations. This article discusses the development and pilot testing of the OTVP in a residential school setting. The OTVP may provide OT practitioners, educators, vocational staff, and employers with information to support young adults seeking supported or competitive employment after high school.

Where do we start? Health care transition in adolescents and young adults with chronic primary pain.

Where do we start? Health care transition in adolescents and young adults with chronic primary pain.

Multi-level factors linked to young adult primary care transitions: evidence from a state all-payer claims analysis

ObjectiveDelayed transitions from pediatric to adult primary care leads to gaps in medical care. State all-payer claims data was used to assess multilevel factors associated with timely transition from pediatric to adult primary care.Materials and methodsWe created a cohort of 4,320 patients aged 17–20 in 2014–2017 continuously enrolled in health insurance 36 months between 2014 and 2019 and attributed to a pediatric provider in months 1–12. We also constructed primary care provider networks identifying links between providers who saw members of the same family. Logistic regression was used to predict adult primary care in months 25–36 on family, provider, and county-level factors. Finally, we modeled the effect of county and network cluster membership on care transitions.ResultsMale sex, having another family member seeing a pediatrician, and residing in a county with high pediatric care capacity or low adult primary care capacity were associated with lower odds of adult primary care transition.DiscussionWe investigated factors associated with successful transitions from pediatric to adult primary care. Family ties to a pediatrician and robust county capacity to provide primary care to children were associated with non-transition to adult primary care.ConclusionMultiple level factors contribute to non-transition to adult primary care. Understanding the factors associated with appropriate transition can help inform state and national policy.

Accuracy of Glucagon Testing Across Transition in Young Adults with Childhood-Onset Growth Hormone Deficiency.

The 2019 AACE guidelines suggested peak GH-cutoffs to glucagon test (GST) of ≤3 µg/L and ≤1 µg/L in the diagnosis of permanent GH deficiency (GHD) during the transition phase. Aim of the study was to evaluate the accuracy of GST compared to insulin tolerance test (ITT) in the definition of GHD at adult height achievement. Ninety-seven subjects with childhood-onset GHD (median age, 17.39 years) underwent ITT, GST and IGF-1 testing; 44 subjects were idiopathic (isolated GHD), 35 moderate organic GHD (0-2 hormone deficiencies-HDs) and 18 severe organic GHD (≥3 HDs). Bland and Altman analysis showed a high consistency of GH peak measures after ITT and GST. Receiver operating characteristic analysis-ROC- identified 7.3 μg/L as the optimal GH peak cutoff to GST (95% CI 4.15-8.91; sensitivity 95.7%, specificity 88.2%, positive predictive value-PPV-88.0%, negative predictive value-NPV-95.7%), able to correctly classify 91.8% of the entire cohort while 5.8 μg/L was the best GH peak cutoff able to correctly classify 91.4% of moderate organic GHD patients (95% CI 3.16-7.39; sensitivity 96.0%, specificity 80.0%, PPV 92.3%, NPV 88.9%). Patients with ≥3HDs showed a GH peak <5μg/L at ITT and <5.8μg/L at GST but one. The optimal cutoff for IGF1 was -1.4 SDS (95% CI -1.94-0.77; sensitivity 75%, specificity 94%, PPV 91.7%, NPV 81.0%) that correctly classified 85.1% of the study population. A GH peak to GST <5.8 μg/L represents an accurate diagnostic cutoff for young adults with childhood-onset GHD and high pre-test probability of permanent GHD.

1848-LB: Peer Mentors in a Young Adult Transition Intervention

1848-LB: Peer Mentors in a Young Adult Transition Intervention

Transitioning from pediatric to adult-oriented healthcare in rheumatology: the pediatric side of the coin.

The transition of adolescents and young adults (AYAs) from pediatric to adult-oriented healthcare may be affected by many factors, including the personal and cultural settings. We aimed to analyze the transition readiness and the factors affecting the transition success in rheumatology. Patients older than 12 years were included in this prospective study. All filled out the Transition Readiness Assessment Questionnaire (TRAQ) 5.0. AYAs were phone-interviewed after their transfer to adult-oriented healthcare. Drug adherence was evaluated with 4-item Morisky Medication Adherence Scale (MMAS-4). AYAs rated their transitional care experience with visual analogue scale (VAS 0-10; 0, the worst; 10, the best). A total of 504 TRAQs were filled out by 406 patients (F/M = 1.5). The total TRAQ score was positively correlated with age and higher in the forms filled out by girls than boys (4.2 vs 4.0, respectively; p= 0.005). The transition was successful for 78 (83.9%) out of 93 patients transferred to adult-oriented healthcare. The VAS for the transition process was lower and the post-transfer MMAS-4 score was worse (8 vs 9, p= 0.030 and 3 vs 4, p= 0.020; respectively) in patients whose transition was not successful when compared with the successfully-transitioned ones. The best-performing TRAQ cut-off value was >4.0 for predicting transfer readiness in rheumatology. A TRAQ score of > 4 could be used while deciding about the transfer readiness of AYAs in rheumatology. Improving the AYAs' experience of the transition process and closely monitoring medication adherence during transition are essential for a successful transition.

Associations Between Stress, Health Behaviors, and Quality of Life in Young Couples During the Transition to Survivorship: Protocol for a Measurement Burst Study.

Cancer is a life-threatening, stressful event, particularly for young adults due to delays and disruptions in their developmental transitions. Cancer treatment can also cause adverse long-term effects, chronic conditions, psychological issues, and decreased quality of life (QoL) among young adults. Despite numerous health benefits of health behaviors (eg, physical activity, healthy eating, no smoking, no alcohol use, and quality sleep), young adult cancer survivors report poor health behavior profiles. Determining the associations of stress (either cancer-specific or day-to-day stress), health behaviors, and QoL as young adult survivors transition to survivorship is key to understanding and enhancing these survivors' health. It is also crucial to note that the effects of stress on health behaviors and QoL may manifest on a shorter time scale (eg, daily within-person level). Moreover, given that stress spills over into romantic relationships, it is important to identify the role of spouses or partners (hereafter partners) in these survivors' health behaviors and QoL. This study aims to investigate associations between stress, health behaviors, and QoL at both within- and between-person levels during the transition to survivorship in young adult cancer survivors and their partners, to identify the extent to which young adult survivors' and their partners' stress facilitates or hinders their own and each other's health behaviors and QoL. We aim to enroll 150 young adults (aged 25-39 years at the time of cancer diagnosis) who have recently completed cancer treatment, along with their partners. We will conduct a prospective longitudinal study using a measurement burst design. Participants (ie, survivors and their partners) will complete a daily web-based survey for 7 consecutive days (a "burst") 9 times over 2 years, with the bursts spaced 3 months apart. Participants will self-report their stress, health behaviors, and QoL. Additionally, participants will be asked to wear an accelerometer to assess their physical activity and sleep during the burst period. Finally, dietary intake (24-hour diet recalls) will be assessed during each burst via telephone by research staff. Participant enrollment began in January 2022. Recruitment and data collection are expected to conclude by December 2024 and December 2026, respectively. To the best of our knowledge, this will be the first study that determines the interdependence of health behaviors and QoL of young adult cancer survivors and their partners at both within- and between-person levels. This study is unique in its focus on the transition to cancer survivorship and its use of a measurement burst design. Results will guide the creation of a developmentally appropriate dyadic psychosocial or behavioral intervention that improves both young adult survivors' and their partners' health behaviors and QoL and potentially their physical health. DERR1-10.2196/53307.

Barriers to Mental Health Care Transition for Youth and Young Adults with Intellectual and Developmental Disabilities and Co-occurring Mental Health Conditions: Stakeholders’ Perspectives

Youth and young adults (YYA) with intellectual and developmental disabilities (IDD) have high rates of co-occurring mental health (MH) conditions. The time during transition from pediatric to adult health and mental health care can be a very challenging, with risk of loss of services leading to poor outcomes. This study aimed to explore barriers to transition from pediatric to adult health and mental health care and services for individuals with IDD and co-occurring MH conditions, by eliciting the view of stakeholders, including disability advocates. Qualitative analysis was conducted using grounded theory, and themes were coded based upon the social-ecological model (SEM). We generated themes into multiple levels: the individual level, the family level, the provider level, the systems of care level, and the societal level. Stakeholders expressed a critical need to improve coordination between systems, and to increase provider availability to care for YYA with IDD and co-occurring MH conditions.

Resource utilization and costs of transitioning from pediatric to adult care for patients with chronic autoinflammatory and autoimmune disorders

BackgroundA structured transition of adolescents and young adults with chronic autoinflammatory and autoimmune disorders from the pediatric to the adult health care system is important. To date, data on the time, processes, outcome, resources required for the necessary components of the transition process and the associated costs are lacking.MethodsEvaluation of resource use and costs in a prospective cohort study of 58 adolescents with chronic autoinflammatory and autoimmune disorders, for the key elements of a structured transition pathway including (i) compilation of a summary of patient history, (ii) assessment of patients’ disease-related knowledge and needs, (iii) required education and counseling sessions, (iv) and a transfer appointment of the patient with the current pediatric and the future adult rheumatologist.ResultsForty-nine of 58 enrolled patients (84.5%) completed the transition pathway and were transferred to adult care. The mean time from the decision to start the transition process to the final transfer consultation was 315 ± 147 days. Transfer consultations were performed in 49 patients, including 10 patients jointly with the future adult rheumatologist. Most consultations were performed by the multidisciplinary team with a median of three team members and lasted 65.5 ± 21.3 min. The cumulative cost of all consultation and education sessions performed including the transfer appointment was 283 ± 164 Euro per patient. In addition, the cost of coordinating the transition process was 57.3 ± 15.4 Euro.ConclusionsA structured transition pathway for patients with chronic autoinflammatory and autoimmune disorders is resource and time consuming and should be adequately funded.

UK guideline on the transition and management of childhood liver diseases in adulthood.

Improved outcomes of liver disease in childhood and young adulthood have resulted in an increasing number of young adults (YA) entering adult liver services. The adult hepatologist therefore requires a working knowledge in diseases that arise almost exclusively in children and their complications in adulthood. To provide adult hepatologists with succinct guidelines on aspects of transitional care in YA relevant to key disease aetiologies encountered in clinical practice. A systematic literature search was undertaken using the Pubmed, Medline, Web of Knowledge and Cochrane database from 1980 to 2023. MeSH search terms relating to liver diseases ('cholestatic liver diseases', 'biliary atresia', 'metabolic', 'paediatric liver diseases', 'autoimmune liver diseases'), transition to adult care ('transition services', 'young adult services') and adolescent care were used. The quality of evidence and the grading of recommendations were appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. These guidelines deal with the transition of YA and address key aetiologies for the adult hepatologist under the following headings: (1) Models and provision of care; (2) screening and management of mental health disorders; (3) aetiologies; (4) timing and role of liver transplantation; and (5) sexual health and fertility. These are the first nationally developed guidelines on the transition and management of childhood liver diseases in adulthood. They provide a framework upon which to base clinical care, which we envisage will lead to improved outcomes for YA with chronic liver disease.

The Case for Early Transition-Planning for Students With Significant Support Needs: Implications for Policy and Practice

The period in which young adults transition from high school is accompanied with complexities they need to navigate, such as further education and training, independent living, developing their career, and achieving meaningful employment. All of these set the stage for a successful and independent life. The significance of this transition is paramount; however, in research and practice, we continue to see poor outcomes for students with disabilities, especially those with the most significant support needs. Transition planning, mandated by the Individuals with Disabilities Education Act, must begin no later than a child turning 16. Some states mandate transition activities to start as early as 14, but should we consider an even earlier age? Within this paper, we discuss the need for changes within policy and practice to begin transition activities during children’s early education years.

The usability and effectiveness of eHealth and mHealth interventions that support self-management and healthcare transition in adolescents and young adults with chronic disease: A systematic review (Preprint)

The usability and effectiveness of eHealth and mHealth interventions that support self-management and healthcare transition in adolescents and young adults with chronic disease: A systematic review (Preprint)

Evaluating the transition of adolescents and young adults with palliative care needs from pediatric to adult care

BackgroundThe transition from pediatric to adult healthcare poses significant challenges for adolescents and young adults (AYA), especially those with chronic conditions, yet most children receive inadequate transition preparation. Research on the transition for patients receiving palliative care services is particularly limited. We sought to address this gap in the literature. MethodsYoung adults aged 18 to 35 years who transitioned from the pediatric setting and received adult palliative care services at an urban academic medical center between the dates of February 1st, 2020 and July 1st, 2022 were identified retrospectively via electronic medical record. Chart review was used to investigate outcomes of interest, including use of pediatric palliative care services and timing of care conversations. ResultsOnly 23 % of patients interfaced with pediatric palliative care, despite all having childhood diagnoses. Pediatric palliative care exposure was associated with a significantly earlier median age of first adult palliative care encounter (19.63 versus 25.06, p = <0.001). Goals of care discussions, code status conversations, and healthcare proxy documentation occurred earlier if pediatric palliative care was involved (18.9 years versus 25.7 years, p < 0.001; 20.9 years versus 30.0 years, p < 0.001; 20.7 versus 28.9, p < 0.001). ConclusionsPediatric palliative care services were underutilized in AYA patients, but when used, were associated with earlier adult palliative care encounters, goals of care discussions, code status decisions, and health care proxy identification.

Health care transition experiences of young adults with medical complexity

BackgroundTransition from pediatric to adult healthcare and services is an important event in the life course of all youth, including youth living with medical complexity. Data from the National Survey of Children’s Health indicates less than 20 % of youth receive health care transition services. The goal of our study was understanding the support, tools and resources that facilitate successful health care transition of young adults living with medical complexity. MethodsYoung adults living with medical complexity and their parents shared their lived experience of ‘what worked’ and ‘what is needed’ for successful health care transition during focus group sessions. Content analysis of transcripts used an iterative and deductive approach guided by a priori themes. FindingsThe voices of ten young adults and fourteen parents were shared during three virtual focus group sessions. They described health care transition (HCT) as an individualized process with success relying on consistent, clearly-defined and systemwide guidelines and resources. Moving from pediatric/family-focused care to adult/patient-focused care requires increased self-management and young adults often felt under-prepared for this role. Support from formal transition coordinators would improve communication between the multiple health, county/state agency and education systems involved during the transition period. ConclusionsUnderstanding the support, tools, and resources specifically needed by young adults with medical complexity for successful pediatric to adult health care transition is a critical first step in addressing the documented lack of transition services for this vulnerable population. This includes formal peer support programs for young adults with medical complexity and their parents.

Improving Transition of Emerging Adults with Sickle Cell Disease to Adult Care through a Multidisciplinary Process: The Development of a Transition Clinic to Support Transition Success

The transition period from pediatric to adult care is challenging for people with sickle cell disease (SCD). Emerging adults with SCD who do not successfully transition have increased acute care utilization, worsened disease severity, and are at risk for early death. Several patient-level and system-level factors impact success of transition. A structured process using tested interventions increases the success of transition for patients with chronic diseases. We sought to develop a multidisciplinary transition program for young adults with SCD using the Got Transition basic components of health care transition, including a dedicated “Transition Clinic.” We established a multidisciplinary transition program for emerging adults with SCD at Cincinnati Children's Hospital (CCHMC) in March 2019. We used QI methods to implement and track transition processes based on the customized Six Core Elements of the Health Care Transition Model (policy/guide, tracking and monitoring, readiness, planning, transfer of care, and transition completion) and the ASH transition toolkit for SCD. The transition team includes physicians, psychologists, nurse practitioners, social workers, and nurse care managers at the pediatric and adult SCD programs (CCHMC and University of Cincinnati) who meet regularly to discuss transitioning/transferring patients, patients who completed transfer, and topics related to transition. Patients are approached at age 14 with a goal to transfer to adult care at age 21. We implemented a “Transition Clinic” dedicated to addressing transition-specific issues (progress on TRAQ-derived goals, self-management, financial counseling, academic planning, introducing members of the adult team). Patients ≥ 18 y.o. are encouraged to attend at least one transition clinic before transfer of care. We measured the short-term success of transition by successfully completing a visit with adult provider within 6 months of the last pediatric visit. We collected data on patients who did and did not attend transition clinic. Between March 2019 and September 2022, 29 emerging adults reached age 21 and transferred to adult care. The mean age of transfer was 21.5 y.o. The patients' genotypes were: 20 HbSS, 7 HbSC, 1 HbSD and 1 HbS ß-thalassemia. Overall, 19/29 attended at least one transition clinic; 18/19 who attended transition clinic had follow up data from an adult facility compared to 5/10 who did not attend transition clinic. Of patients who attended transition clinic, 17/19 completed a visit with an adult provider within 6 months of the last pediatric visit compared to 1/10 in patients who did not attend. The mean time between the last pediatric visit and first visit with an adult provider was 77 days among those who attended transition clinic vs 321 days among those who did not attend a clinic. There was no difference between the 2 groups in age of transfer (21.6 vs 21.2 y.o), sex (females 47% vs 40%), or insurance type. However, the proportion of patients with SS genotype was higher among patients who attended transition clinic compared to those who did not (SS 79% vs 50%). Our team successfully developed and implemented a transition clinic, as part of a multidisciplinary transition program, to support the successful transition of young adults with SCD to adult care. Most patients who attended a transition clinic made it to an adult provider within 6 months. Individuals who did not attend transition clinic were more likely to be lost to follow up or have delayed adult care. Future research should examine the barriers to clinic attendance as there is likely a correlation between patients who have the tools to be able to attend a transition clinic and patients who are successful navigating a new medical system. Considering patients with HbSS had a more successful transition, next steps should include identifying factors that contribute to their success to better support patients with other genotypes. In conclusion, the implementation of a multidisciplinary process by a dedicated pediatric and adult team may increase SCD patients' success to transition to adult care. Efforts should be made to understand barriers for patients with non-SS genotypes and patients who have been unable to attend a transition clinic. Long term goals include identifying ways within the pediatric clinic to better incorporate the adult team and to measure long-term success of transition and its impact on health care utilization.

A Novel Receivership Model for Transition of Young Adults With Diabetes: Experience From a Single-center Academic Transition Program

ObjectiveThe transition from pediatric to adult care for young adults with diabetes represents an important but often challenging time characterized by a shift from a family-centered care model of pediatrics to a patient-centered care model of adult medicine. We developed a structured transition program based on an adult receivership model at a large academic medical center to improve care coordination and patient satisfaction with the transition process. MethodsFrom 2016 to 2020, we implemented a series of quality improvement efforts for young adults aged 18 to 23 years with diabetes by incorporating best practices from the American Diabetes Association guidelines on care for emerging adults. We measured transition orientation attendance, patient satisfaction, hemoglobin A1c (HbA1c) pre- and post-transfer, and care gaps to determine the impact of the program. ResultsIn this study, 307 individuals with type 1 diabetes and 16 individuals with type 2 diabetes were taken care of by the adult endocrinology department at the University of Michigan between January 1, 2016 and October 31, 2020. We observed high attendance rates (86% among internal transfers) and favorable patient satisfaction scores for the transition orientation session. Despite the glycemic challenges posed during the transition, HbA1c modestly yet significantly improved 1-year after transfer (−0.4%, P < .01). ConclusionWe successfully established and maintained a young adult diabetes transition program using a quality improvement approach. Future work will focus on reducing care gaps at the time of transfer, assessing long-term retention rates, and enhancing care coordination for patients referred from outside the health network.