title: Pediatric to adult transition: a quality improvement model for primary care.
abstract: OBJECTIVE
  To examine the relationship between quality improvement activities with pediatric and adult primary care practices and improvements in transition from pediatric to adult care.
  
  
  METHODS
  This was a time-series comparative study of changes in pediatric and adult practices involving five large pediatric and adult academic health centers in the District of Columbia. Using the Health Care Transition Index (pediatric and adult versions), we examined improvements in specific indicators of transition performance, including development of an office transition policy, provider knowledge and skills related to transition, identification of transitioning youth, transition preparation of youth, transition planning, and transfer of care.
  
  
  RESULTS
  Improvements took place in all six transition quality indicators in the pediatric and adult practices that participated in a 2-year learning collaborative to implement the "Six Core Elements of Health Care Transition," a quality improvement intervention modeled after the American Academy of Pediatrics/American Academy of Family Physicians/American College of Physicians Clinical Report on Transition. All sites established a practice-wide policy on transition and created an organized clinical process for tracking transition preparation. The pediatric sites conducted transition readiness assessments with 88% of eligible youth and prepared transition plans for 29% of this group. The adult sites conducted transition readiness assessments with 73% of eligible young adults and developed plans for 33%. A total of 50 were transferred in a systematic way to adult primary care practices.
  
  
  CONCLUSIONS
  Quality improvement using the Six Core Elements of Health Care Transition resulted in the development of a systematic clinical transition process in pediatric and adult academic primary care practices.
authors.affiliation: The National Alliance to Advance Adolescent Health, Washington, DC. Electronic address: mmcmanus@thenationalalliance.org.
authors.forename: Margaret
authors.initials: M
authors.lastname: McManus
authors.affiliation: The National Alliance to Advance Adolescent Health, Washington, DC.
authors.forename: Patience
authors.initials: P
authors.lastname: White
authors.affiliation: Departments of Medicine and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: April
authors.initials: A
authors.lastname: Barbour
authors.affiliation: Department of Family Medicine, Howard University College of Medicine, Washington, DC.
authors.forename: Billie
authors.initials: B
authors.lastname: Downing
authors.affiliation: Department of Pediatrics, Georgetown University School of Medicine, Washington, DC.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Hawkins
authors.affiliation: Department of Adolescent and Young Adult Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Quion
authors.affiliation: Department of Adolescent and Young Adult Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Lisa
authors.initials: L
authors.lastname: Tuchman
authors.affiliation: Crotched Mountain Foundation, Concord, New Hampshire.
authors.forename: W Carl
authors.initials: WC
authors.lastname: Cooley
authors.affiliation: Children's Health Services Research Division, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Jeanne W
authors.initials: JW
authors.lastname: McAllister
mesh_terms: D000293:Adolescent; D000328:Adult; D004219:District of Columbia; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000592:standards* / Q000706:statistics & numerical data; D060305:Transition to Adult Care / Q000592:standards* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Adolescents; Primary care; Quality improvement; Transition to adult care; Young adults