Health Care Transitions最新文献

{"title":"Freeman Center for intellectual and developmental disabilities: Patient-centered interdisciplinary care","authors":"Joshua Smith ,&nbsp;Brittany N. Hand ,&nbsp;Emily Johnson ,&nbsp;Corey Keeton ,&nbsp;Lauren Wang","doi":"10.1016/j.hctj.2023.100003","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100003","url":null,"abstract":"<div><h3>Objectives</h3><p>Adults with intellectual or developmental disabilities (IDD) face substantial barriers to accessing high-quality, patient-centered care. This paper describes the development and evolution of the Freeman Center, an integrated, interdisciplinary center developed using feedback from adults with IDD and their family members.</p></div><div><h3>Methods</h3><p>We evaluated the reach of the Freeman Center services and described the patient population.</p></div><div><h3>Results</h3><p>As of November, 2022, 1068 patients were seen at the Freeman Center. These patients represent about 5 % of all people with IDD in Hamilton County Ohio, where the Freeman Center is located. On average in 2022, the Freeman Center provided approximately 380 primary care visits, 47 psychiatry visits, and 85 combined primary care and psychiatry service visits per month.</p></div><div><h3>Conclusions</h3><p>Patient demographic characteristics are largely consistent with the general population of Hamilton County, indicating patients are representative of the county the clinic primarily serves. Further work is needed to evaluate patient outcomes at the Freeman Center.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100003"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49744034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parentyouth interactions: Transitioning to toileting self-management in spina bifida patients","authors":"Tae Kawahara,&nbsp;Akemi Yamazaki","doi":"10.1016/j.hctj.2023.100009","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100009","url":null,"abstract":"<div><h3>Purpose</h3><p>Spina bifida (SB) involves neurogenic bladder and bowel deficits. While parents manage the bladder and bowel disorders of their youth in the early years, the youth themselves must eventually take responsibility for their own management. However, the experience of shifting responsibility for complex toilet management from the parents to the youth has not been thoroughly investigated. Therefore, as exploratory research, the present study aimed to reveal the interactions between parents and youths with SB during the time of increasing responsibility for bladder and bowel management (i.e., the transition phase).</p></div><div><h3>Methods</h3><p>Twelve parent–youth pairs (youths with SB aged 11–18 years) participated in dyadic interviews, and a parent–youth transition experience was categorized by the context of parent–youth interactions and analyzed using the grounded theory approach.</p></div><div><h3>Results</h3><p>The results indicated that parents provide professional, complete bladder and bowel management until their youth reach physical and mental maturity. During the transitional phase, they work together to master youth self-management in interactions described as “share, try, and decide through parent–youth interactions”. Finally, the youth are able to master control of their own bladder and bowel management without requiring assistance from their parents.</p></div><div><h3>Conclusions</h3><p>Although parent–youth interactions are not always present during the pre- and post-transition phases, the parent–youth relationship acts to facilitate the independence of the youth by taking advantage of the parent–youth subsystem during the transitional phase. Interventions during these challenging periods could help facilitate the transition to bladder and bowel self-management among the youth.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100009"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49763827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roundtable on Young Adults with IBD: A multi-stakeholder perspective and patient-driven analysis of the current transitional challenges and gaps in research","authors":"Sneha Dave ,&nbsp;Sydney Reed ,&nbsp;Kajal Patel ,&nbsp;Sandra C. Kim","doi":"10.1016/j.hctj.2023.100006","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100006","url":null,"abstract":"<div><p>The “Roundtable on Young Adults with IBD” is a year-long learning community consisting of monthly discussions between providers, patients, and healthcare partners. The group aims to enhance outcomes for the young adult IBD patient population. The first discussion centered on the difficulties that IBD patients face during the transition from pediatric to adult care and how care can be improved for young adult patients during this phase. The group discussed the need to identify developmental milestones for young adult patients, further screening for disordered eating, and the importance of collaboration between specialists and pediatric and adult providers for a successful transition. Additionally, the group highlighted areas of concern such as the spread of misinformation through social media, social determinants of health, and the potential lifelong psychosocial, mental, and economic burdens of IBD for the young adult patient population.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100006"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49743484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a specialty transition clinic: Inaugural clinical and financial operations","authors":"Wendy N. Gray ,&nbsp;Erin Benekos ,&nbsp;Courtney Malave ,&nbsp;Lauren Partain ,&nbsp;Parasto Dorriz ,&nbsp;Michael Weiss","doi":"10.1016/j.hctj.2023.100024","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100024","url":null,"abstract":"<div><h3>Purpose</h3><p>Few examples of hospital-wide transition programs have been presented in the literature and to date, we have no data on the clinical and financial operations of such services.</p></div><div><h3>Design and methods</h3><p>A transition clinic, guided by Got Transition’s Six Core Elements, was created for youth with moderate-to-high medical and psychosocial complexity (per Bob’s Levels of Social Support scale). The clinic visit and transition readiness assessment (UNC TR_xANSITION Index) were billed fee-for-service or under a bundled payment managed care model. We present data on patient characteristics, clinic operations, finances, and patient/parent satisfaction (online survey) in the clinic’s first year of operation (March 2021-February 2022).</p></div><div><h3>Results</h3><p>In Year 1, the clinic completed 115 appointments (113 unique patients). Most patients were older adolescents/young adults (M = 19.7 ± 1.8 years) and nearly half were Latinx. Patients presented with several complex medical needs including coordination of care across multiple subspecialties, high health care utilization, decision-making determinations, behavioral and mental health concerns, and resource needs. Implementation of the Six Core elements was high (range 99.1%−100%). The average billed per patient was $498 (in 2021–2022 USD). Considering paid and unpaid office visits, we collected an average of 31.6 cents on the dollar. Almost 80% of office visit claims and 21.9–33.3% of transition readiness assessments were paid by insurers. Patient/parent satisfaction was high, with over 90% of families reporting that they learned something, knew one thing they could do to improve transition readiness, and were able to get their questions asked and answered.</p></div><div><h3>Conclusions</h3><p>Transition clinics may never be fully self-sustainable given low collection rates and inability to capture extra charge codes related to chronic care management and transitional care. However, our collection rate was on-par with the collection rate for our hospital’s subspecialty clinics and we show it is possible to receive some funding from insurers.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100024"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49743765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on health care transition among U.S. parents of internationally adopted children living with HIV: A qualitative study","authors":"Faith Glover ,&nbsp;Rosemary Olivero ,&nbsp;Cynthia Fair","doi":"10.1016/j.hctj.2023.100010","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100010","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze perspectives on health care transitions among parents who have internationally adopted children living with HIV (IACH)The transition of youth with living with HIV from pediatric to adult care is associated with adverse health outcomes, including poor medication adherence and appointment attendance. However, little is known about the experiences of IACH.</p></div><div><h3>Methods</h3><p>This qualitative project explores the perspectives of 17 parents of 24 IACH in the United States through hour-long semi-structured phone interviews focused on healthcare transition. The purposive sample was recruited from two pediatric infectious disease clinics and private social media sites. Drawing on analytic principles of constant comparison, transcripts were analyzed for emergent themes.</p></div><div><h3>Results</h3><p>Most parents identified as white (<em>n</em> = 16), female (<em>n</em> = 16). Median age of IACH was 16 years. Two had transitioned to adult care. Fourteen did not have a transition plan with their provider. Many parents expressed apprehension regarding the transition to adult care. Anxiety over the ability to communicate with their child’s health provider and lack of comprehensive planning were expressed. Parents also felt their child may feel out of place in the adult infectious disease clinic and emphasized the trusting, long standing relationship with pediatric providers. Participants acknowledged that transition to another provider could be challenging for their child as adult providers may be less aware of adoption-related trauma.</p></div><div><h3>Conclusion</h3><p>It is vital that physicians consider trauma-informed care throughout the transition process with IACH. Providers should support health management-related independence of both IACH and their parents prior to transition. Coordination with adult care providers is key to a successful health care transition.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100010"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49763825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peer support interventions for young adults with inflammatory bowel diseases","authors":"Sneha Dave ,&nbsp;Amy Bugwadia ,&nbsp;Sara Ahola Kohut ,&nbsp;Sydney Reed ,&nbsp;Mara Shapiro ,&nbsp;Hilary K. Michel","doi":"10.1016/j.hctj.2023.100018","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100018","url":null,"abstract":"<div><p>The “Roundtable on Young Adults with Inflammatory Bowel Diseases (IBD)” is a year-long learning community organized by the Crohn’s and Colitis Young Adults Network with monthly discussions between healthcare professionals, patients, and community-based partners. The group aims to improve outcomes for the young adult IBD patient population. The roundtable discussion highlighted in this article centered on the critical importance of peer support for adolescents and young adults (AYA) with IBD. The discussion underscored the need for increased research in peer support, the need to further consider peer support as an intervention, and the value of multi-stakeholder, peer-led collaboration in reducing isolation for young adults with IBD. Additionally, the group identified areas of opportunity, such as developing more appropriate metrics and scales to prove the inherent value of peer support for young adults with IBD.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100018"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49743771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best practices to support inflammatory bowel disease patients in higher education and the workplace: A clinician’s guide","authors":"Sydney Reed ,&nbsp;Sneha Dave ,&nbsp;Amy Bugwadia","doi":"10.1016/j.hctj.2023.100017","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100017","url":null,"abstract":"<div><p>The rising prevalence of inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, among adolescents and young adults illuminates the growing need for psychosocial and structural support for these patients as they navigate both higher education and entering the workforce. In a roundtable discussion hosted by the Crohn’s and Colitis Young Adults Network (CCYAN), medical professionals (physicians, nurses, psychologists, trainees/medical students) and young adult patients with IBD came together to identify best practices for leveraging existing resources to support patients in higher education and their early careers. The discussion explored the topics of ableism and existing barriers in higher education and the workplace, including accommodation processes and the significance of proactive planning and collaboration between patients and their pediatric or adult care providers; the crucial role of establishing a therapeutic alliance; highlighting the importance of adopting a \"whole person\" care approach and normalizing discussions about the psychosocial facets of IBD; and finally, addressing the challenges associated with disease disclosure to empower patients and further build their self-efficacy.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100017"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49743711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What it looks like to ‘mind the gaps’ in a Midwest survivorship clinic for childhood cancer survivors","authors":"Stijn Hentzen ,&nbsp;Taylor Adams ,&nbsp;Kyla Alsman ,&nbsp;Carolyn R. Bates ,&nbsp;Becky Lowry","doi":"10.1016/j.hctj.2023.100021","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100021","url":null,"abstract":"<div><h3>Background</h3><p>As cancer prevalence increases and treatment improves, the population of childhood cancer survivors (CCS) will see remarkable growth. This population requires guideline-based survivorship care into adulthood; however, numerous gaps in care are common including record documentation, medical knowledge, and access to healthcare. Here we describe the patients seen in a US Midwest survivorship transition clinic (STC) and the aspects of the clinic designed to address the gaps in care this cohort faces.</p></div><div><h3>Methods</h3><p>After IRB approval, a retrospective chart review was completed for patients established in the STC between 2014 and 2022.</p></div><div><h3>Results</h3><p>A total of 261 patients were identified. The patients had an average age of 12 years at the time of cancer diagnosis and an average age of 28 years at clinic establishment. Patients presented from 9 states and 139 zip codes. We identified 42 different primary cancers with acute lymphoblastic leukemia (24.5%) and Hodgkin’s Lymphoma (19.2%) most common. We found that 244 (93.5%) received chemotherapy, 138 (52.9%) received radiation, and 41 (15.7%) underwent bone marrow transplant. Secondary malignancies were diagnosed in 29 (11.1%) patients with breast (23.3%) and thyroid (23.3%) malignancies most common.</p></div><div><h3>Discussion</h3><p>The clinical diversity, complex treatment history, and prevalence of secondary malignancies in this CCS population emphasizes the importance close follow-up and adherence to survivorship guidelines. Through strong local partnerships and a specialized nursing navigator this STC addresses care gaps common in this population. Although limitations persist, STCs are a strong model of care to address the unique care needs of this growing population of complex patients.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100021"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49743555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Health Care Transitions Journal: Carpe diem!","authors":"Cecily L. Betz,&nbsp;Maria E. Díaz-González de Ferris","doi":"10.1016/j.hctj.2023.100001","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100001","url":null,"abstract":"","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100001"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49743715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a transition program for pediatric patients with renal disease","authors":"Sahar Siddiqui ,&nbsp;Cortney Taylor Zimmerman ,&nbsp;Brittany Garza ,&nbsp;Sai Kaumudi Saridey ,&nbsp;Constance M. Wiemann","doi":"10.1016/j.hctj.2023.100014","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100014","url":null,"abstract":"<div><h3>Background</h3><p>The transition from pediatric to adult health care is challenging for patients with renal disease and inadequate transition can lead to increased disease-related morbidity. We developed a structured health care transition (HCT) program that includes a joint two-step transition clinic; the first step is the pediatric clinic and second step is the adult clinic.</p></div><div><h3>Methods</h3><p>Quality improvement methodology was utilized to establish an interdisciplinary transition team and conduct a needs assessment. Lack of a standardized HCT program was identified as a primary barrier to HCT. We utilized transition team and other stakeholder input to implement a transition program that included a joint pediatric/adult two-step transition clinic. Various other components were developed, including a transition policy and patient and provider feedback surveys. A pilot group of patients with kidney disease participated in the program.</p></div><div><h3>Results</h3><p>27 patients completed the “first step” and 22 patients completed the “second step” of the transition clinic. Median age at the time of transition was 20 years, with kidney transplant (41 %) as the major diagnosis. All patients (100 %) received the transition policy and reported that the transition team worked with them to gain skills to manage their health and plan for the future. Pediatric and adult nephrologists reported feeling satisfied (100 %) with the transition program.</p></div><div><h3>Conclusion</h3><p>A structured transition program was established utilizing expertise of a dedicated transition team and was well received by participants. This program is a critical first step in addressing the gap in standardized care for transition for pediatric patients with kidney disease.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100014"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49743863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}