Center-Based Quality Initiative Targets Youth Preparedness for Medical Independence: HEMO-Milestones Tool in a Comprehensive Hemophilia Clinic Setting.
BACKGROUND
Patient transition readiness self-assessment tools and investigation into patient and parent perceptions of the transition process from pediatric to adult care models have informed recognition of gaps in care, particularly for those with chronic disease. Implementation of a longitudinal transition process with patient tracking provides the opportunity for individualized education and skill building and fosters a patient-centered model.


METHODS
Quality improvement intervention was used to assess and improve our transition process at annual comprehensive clinic visits for patients with bleeding disorders at our tertiary care pediatric center.


RESULTS
Thirty-one patients with rare bleeding disorders received an introduction to the transition process using the HEMO-milestones tool in our hemophilia comprehensive clinic from September to December 2014. The percentage of patients with documented, age-specific hemophilia knowledge/skill assessment increased from 21% to 97%. The percentage of patients with documented skill building or adult care transfer plan increased from 55% to 93%. Designated postclinic team debriefings facilitated the creation of collaborative documentation summarizing each patient's transition readiness and plan for continued skill building.


CONCLUSIONS
The HEMO-milestones tool promotes a standardized approach to evaluation of self-management competency. When combined with a collaborative multidisciplinary effort, it increases plans for skill building in patients with hemophilia. This tool is easily modifiable for alternate subspecialty use and does not require extensive training for implementation.
Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston Hemophilia Center, Harvard Medical School, Boston, Massachusetts.
Stacy E
SE
Croteau
Boston Children's Hospital, Boston, Massachusetts.
Maura
M
Padula
Boston Children's Hospital, Boston, Massachusetts.
Kate
K
Quint
Boston Children's Hospital, Boston, Massachusetts.
Loren
L
D'Angelo
Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston Hemophilia Center, Harvard Medical School, Boston, Massachusetts.
Ellis J
EJ
Neufeld
D000293:Adolescent; D005260:Female; D006467:Hemophilia A / Q000628:therapy*; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D012648:Self Care; D060305:Transition to Adult Care
quality improvement; self-management skills; transition