transition programs Kathy Nixon Speechley Professor, Paediatrics, - - PowerPoint PPT Presentation
Measuring outcomes of transition programs Kathy Nixon Speechley Professor, Paediatrics, Epidemiology & Biostatistics, Western University Scientist, Division Chair, Childrens Health Research Institute Assistant Director, Lawson Health
Professor, Paediatrics, Epidemiology & Biostatistics, Western University Scientist, Division Chair, Children’s Health Research Institute Assistant Director, Lawson Health Research Institute London, Ontario, Canada
Grants/Research Support: CIHR Children’s Health Research Institute/ Children’s Health Foundation, London. ON
None to report
Evaluate effectiveness of interventions designed to improve transition of care
AUTHORS’ CONCLUSIONS:
“The available evidence (four small studies; N = 238), covers a limited range of interventions developed to facilitate transition in a limited number of clinical conditions, with only four to 12 months follow-up. These follow-up periods may not be long enough for any changes to become apparent as transition is a lengthy process. Evidence of improvement in patients' knowledge of their condition in one study, and improvements in self-efficacy and confidence in another. However, few studies eligible for review and overall certainty of the body of this evidence is low, no firm conclusions can be drawn about the effectiveness
important impact on our confidence in the intervention effect and likely could change our conclusions. Considerable scope for the rigorous evaluation of other models of transitional care, reporting on clinical
four small studies a limited range of interventions a limited number of clinical conditions
may not be long enough for any changes to become apparent Evidence of improvement in patients' knowledge of their condition improvements in self-efficacy and confidence
evidence is low, no firm conclusions can be drawn “Further research is very likely to have an important impact on
2017
the transfer & compared outcomes either between intervention & control group OR between pre- & post-intervention in single group. Randomized control groups used in 23%
“Despite the wealth of literature concerning aspects of transitional care that are key to a successful transition for young people with JIA or epilepsy, there is a paucity of
a lack of reliable research evaluating the effectiveness of transitional care interventions to support young people moving to adult health services.”
there is a paucity of outcomes that define ‘successful’ transition and consequently a lack of reliable research evaluating the effectiveness of transitional care interventions to support young people moving to adult health services
making it difficult to draw conclusions
challenge of mounting rigorous evaluations of typically complex interventions designed to improve transition
e.g. Fletcher-Johnston et al (2011); Le Roux et al (2017); Gabriel et al (2017); Burke et al (2018); Prior et al (2018)
entails (guidelines, recommendations, consensus statements)
principles
Answer is necessary to:
transition program & indicators to use to assess success
& indicators (quantifiable chars.) to describe transition as successful
Options: remain unchanged; remove; re-formulate; merge with another key element/indicator. Space to add rationale.
removed)
ESSENTIAL ELEMENTS %
Assuring good coordination between pediatric and adult professionals 97 Starting planning transition at an early age 77 Discussing with patient and Family about self-management 74 Including young person's views and preferences to the planning of transition 74 If developmentally appropriate, seeing the adolescent alone at least for part of the transition 71 Identifying an adult professional willing to take on the young person 71
Essential (%) Essential+ very Important (%) Patient not lost to follow-up 91 Attending scheduled visits in adult care 63 94 Patient building a trusting relationship with adult provider 43 86 Continuing attention for self management 49 86 Patients' first visit in adult care no later than 3-6mo. 60 83 Number of ER visits for regular care in the past year 40 80 Patient and family satisfaction with transfer of care 34 74 Maintenance/ improvement of standard for disease control evaluation 37 71
diseases e.g. indicator of Pt’s first visit in adult care no later than 3-6 mo should likley be different depending on disease
practices and resources (e.g. “# ER visits for regular care“)
care in general and not specific to transition
services appeared almost constantly (key is collaboration)
youth reach full potential but consensual elements mainly limited to health outcomes and less holistic
supporting transition define success; what defines successful transition is dependent on stakeholder perspective (Burke et al,
2018
family perspective
Process of transition:
Short-term Outcomes:
Longer-term Outcomes:
measurement, important to employ a conceptual framework
(Prior et al, 2018; Gorter et al, 2014)
(CAPHC Guideline for Transition, 2016)
Two examples:
Framework (ICF) (WHO)
Patient Experience of Care
Satisfaction Barriers to Care Enablers
Population Health
Adherence to care guidelines Disease-specific outcome Mortality Patient-reported outcomes (QOL & functional status) Self-care skills Process of care
Cost
Gaps in care Cost of no shows Cost per patient Service use-- short-term & longitudinally Accessing outpatient vs. emergency vs. inpatient care
(Prior et al, 2015) e.g. Triple aim: population health, patient experience & cost
transition intervention with system-wide improvements in health care
sensitive components such as relationships, opportunity & experience impact outcomes as part of developmental process or trajectory.
Areas for improvement in methodological quality:
viewed as priority
indicators of successful outcome have been systematically determined