title: Transitioning youth with rheumatic conditions: perspectives of pediatric rheumatology providers in the United States and Canada.
abstract: OBJECTIVE
  To assess North American pediatric rheumatology providers' perspectives on practices, barriers, and opportunities concerning the transition from pediatric-centered to adult-centered care.
  
  
  METHODS
  Childhood Arthritis and Rheumatology Research Alliance (CARRA) members completed a 25-item survey assessing current transition practices, transition policy awareness, and transitional care barriers and needs. Results were compared to the American Academy of Pediatrics (AAP) 2008 survey on transitional care.
  
  
  RESULTS
  Over half (158/288, 55%) of CARRA members completed the survey. Fewer than 10% are very familiar with AAP guidelines about transition care for youth with special healthcare needs. Eight percent have a formal written transition policy, but 42% use an informal approach. Patient request (75%) most frequently initiates transfer to adult care. Two major barriers to transition are fragmented adult medical care and lack of sufficient time to provide services. Compared with AAP survey participants, pediatric rheumatology providers are significantly more likely to help youth find an adult specialist (63% vs 45%) and discuss confidentiality and consent before age 18 (45% vs 33%), but are less likely to help with medical summary creation (16% vs 27%) or find a primary care provider (25% vs 47%). Outcomes ranked as "very important" in defining a successful transition are survival (76%), seeing an adult rheumatologist within 6 months of final pediatric rheumatology visit (66%), and maintaining insurance coverage (57%).
  
  
  CONCLUSIONS
  This comprehensive survey of North American pediatric rheumatology providers regarding transitional care practices demonstrates deficiencies in education, resources, and a formalized process. Respondents support development of standardized rheumatology-specific transition practices.
authors.affiliation: From the Department of Pediatrics, Section of Pediatric Rheumatology, Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatrics, Pediatric Rheumatology Division, George Washington University School of Medicine, Washington, DC; Departments of Medicine and Pediatrics, Adult and Pediatric Rheumatology, Ohio State University, Columbus, Ohio; Joint Health and Autoimmune Diseases, George Washington University School of Medicine and Health Sciences and the Arthritis Foundation, Washington, DC, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Chira
authors.forename: Tova
authors.initials: T
authors.lastname: Ronis
authors.forename: Stacy
authors.initials: S
authors.lastname: Ardoin
authors.forename: Patience
authors.initials: P
authors.lastname: White
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D005260:Female; D019538:Health Care Surveys; D006282:Health Personnel / Q000458:organization & administration; D006801:Humans; D008297:Male; D010372:Pediatrics; D011787:Quality of Health Care; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000628:therapy*; D012219:Rheumatology / Q000592:standards / Q000639:trends; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care / Q000592:standards* / Q000639:trends; D014481:United States; D055815:Young Adult
keywords: ADOLESCENTS; PEDIATRIC RHEUMATOLOGY; PRACTICE GUIDELINES; SURVEYS; TRANSITIONAL CARE