Development of a Transition Program for Young Adults with Type 1 Diabetes Progressing from Pediatric to Adult Care – A Feasibility Study

ABSTRACT Development of a Transition Program for Young Adults with Type 1 Diabetes Progressing from Pediatric to Adult Care – A Feasibility Study Elizabeth A. Minchau Background: Emerging adulthood requires a delicate balance of the competing social, educational, occupational, and financial demands typical of this developmental stage. This time period presents special challenges for adolescents with type 1 diabetes (T1D), who must also prioritize consistent medical follow-up and ongoing intensive self-care. Emerging adults with T1D struggle with glycemic control that is further exacerbated by an often-times disorganized transfer of care between pediatric and adult endocrinology practices. Substantial gaps in care have been noted during this transition process and can lead to suboptimal health care utilization, worsening glycemic control, increased incidence of serious complications, and mental health challenges. A formal healthcare transition process can help prevent gaps in care, improve independent disease management skills and markers of disease control, decrease disease burden, and reduce acute and chronic diabetes complications. Purpose: There is an increased focus within the pediatric community to formally prepare young adults with T1D for independent disease management as they transition to the adult service line. The purpose of this project was to adapt a federal transition framework to an outpatient pediatric endocrinology clinic in a northern West Virginia tertiary care center. A transition program titled, Preparing Emerging Adults with Knowledge and Skills (PEAKS), was designed to help meet the current standard of care. This project had two aims: Aim 1: Adapt the federal “Got Transition” framework to the specific needs of a local pediatric endocrinology clinic and Aim 2: Examine the feasibility of the PEAKS program design. Methods/Interventions: “Got Transition’s” Six Core Elements of Health Care Transition were adapted to the unique needs of the pediatric endocrinology setting by incorporating diabetes-specific transition guidelines recommended by the ADA Transitions Working Group. The PEAKS program targeted patients between the ages of 16-18 and offered structured transition visits (built into the electronic health record) which focused on enhancing knowledge and skills related to the management of T1D. The Model for Improvement’s Plan-Do-Study-Act (PDSA) framework was used to guide the project. Stakeholder feedback related to the acceptability and practicality of key program elements was collected at two time-points during program implementation to evaluate feasibility. Results: The final program design incorporated all six of “Got Transition’s” Six Core Elements of Health Care Transition and was trialed with patients over a four-month time period. Data from stakeholder interviews found the finished product to be both acceptable and practical. The program’s transition-focused education, documentation, and formal transfer of care processes did increase appointment times, resulting in stakeholders reporting increased time-burden. Conclusions: Utilizing the PEAKS program framework to formalize and organize the transition process for emerging adults with T1D appears to be an acceptable and practical way to begin to bridge the identified gap between current practice and best practice. The PEAKS program exemplified the science behind organized transitional care processes and helped stakeholders actualize team-based approaches, interdisciplinary communication, and patient-centered care