Putting   the   Six   Core   Elements   of   Health   Care
Transition   into   Practice
Using   Quality   Improvement:
The   Experience   of   Four   Got   Transition
Learning   Collaboratives
2012   AMCHP   Annual   Conference
February   13,   2012
Washington,   DC
W.
Carl   Cooley,   MD
Jeanne   W.
McAllister,   BSN,   MS,   MHA
Nathalie   Quion,   MD,   MPH
“We   have   no   relevant   financial   relationships   with   the   manufacturer(s) of any commercial product(s) and/or   provider(s)   of   commercial   services   discussed   in   this   CME   activity.”
• Changing   systems   – BTS   Learning   Collaboratives
• Best   practice   – HCT   Clinical   Report
• Translating   the   report   – Six   Core   Elements
• Transforming   practices   – Four   learning   collaboratives
• Engaging   practices   in   your   community
Got   Transition   is supported   by   cooperative   agreement
U39MC18176   HRSA/US   MCHB
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CHANGING   THE   BEHAVIOR   OF   HEALTH   SYSTEMS
• Causing   change   to   occur
– Education   and   information   is   not   enough
– Traditional   continuing   education   is   not   very   effective
– Change   is   hard
• Some   methods   work
– Relationship ‐ based   training   – academic   detailing
– Q lit i improvement t   th d   li d   t i ll   k
• The   Breakthrough   Series   Learning   Collaborative   model
– Applying   lessons   of   other   industries   to   health   care
– Evidence ‐ based
– Based   on   structure   and   commitment   to   the   process
Changing   health   systems
Changing   the   behavior   of   individuals
• Are   you   involved   with   making   quality   improvement   changes   at   your   organization?
• Who   is   involved   in   QI   efforts   outside   of   your   organization?
• Who   is   involved   in   public   health   efforts   that   touch   on   youth   directly?
Families   directly?
• What   about   improvement   and   change   efforts   with   primary   care   practices?
– Medical   Home
– Prenatal
– Other   examples?
Breakthrough   Series   Learning   Collaborative   Model
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DESIGNING   A   BTS   LC   FOR   HEALTH   CARE   TRANSITION
• Unique   features
– Dyads   of   pediatric   and   adult   practices
– Working   across   organizations   to   improve   care
– Consumer   involvement
• including   youth/young   adults
• Design   and   timelines
– Teaching   and   learning   strategies
– Practice ,   accountability,   shared   learning
PRACTICE   PERSPECTIVE:   WORKING   AS   A   TEAM
• CNMC   Children’s   Health   Center   Team
• Learning   together   with   other   practice   teams
• Learning   collaborative   as   a   way   of   implementing change – how was it helpful (or   challenging?
)
• Linked   to   the   clinical   report
• Effort   to   distill   HCT   improvement   down   to   the   most   basic   structures/processes
• Vetting   feasibility   and   value   in   the   LCs
• Associated   tool   set
• Measuring   using   HCT   Index
• Find   them   here… http://www.gottransition.org/6 ‐ core ‐ elements
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HEALTH   CARE   TRANSITION   CLINICAL   REPORT
• Published   in   Pediatrics,   July   2011
• Developed   by   an   expert   authoring   group
• Jointly   authored   by   AAP,   AAFP,   and   ACP
• Reviewed   by   large   and   diverse   constituency
HEALTH   CARE   TRANSITION   CLINICAL   REPORT
• Targets   all   youth
• Algorithmic   structure   provides   logical   framework
– Branching   for   youth   with   special   health   care   needs
– Provides   framework   for   future   condition   or   specialty   specific   applications
• Explicit   guidance   about   practice   structure   and   process   beginning   at   the   12   year   check ‐ up
• Extends   through   the   transfer   of   care   to   an   adult   medical   home   and   adult   specialists
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• into   a   series   a   systems   change   agenda
• The   Six   Core   Elements   of   Health   Care   Transition
– Core   changes   needed   to   affect   good   transitions
– C   b i l d   i ll i in   a   QI   process
– Linked   to   tested   tools   for   each   core   element
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• What   Was   Valuable
• Other   Observations   of   6   Core   Elements
• Data   re:   implementation   of   6   core   elements
• HCT   Index   data
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MEASURING   HEALTH   CARE   TRANSITION   IN   PRACTICES…
• Health   Care   Transition   Index
– Provides   a   numerical   score   for   HCT   implementation
– Modeled   after   the   Medical   Home   Index
– Pediatric   setting   version   and   adult   setting   version
• Tracking   implementation   goals   in   practices
– Written   transition   policy   in   place
– Number   of   youth   enrolled   in   registry
– Number   of   readiness   assessments   completed
– Number   of   transition   plans   in   place
– Number   of   transfer   of   care   to   adult   settings
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‐
8
7
6
5
Scores 4
3
2
1
0
Pre   LC,   Feb.
2011
Post   LC,   Oct.
2011
1 2 3
Core   Elements
4 5 6
8

• %   of   practices   with   HCT   policy
• Total   youth   in   registries
• Total   readiness   assessments
• Total transition plans
• Total   transfers   to   adult   care
100%
442
176
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TIPS   ON   STIMULATING   HCT   IMPROVEMENT   IN   PRACTICES
• Working   with   professional   organizations
– Engage   state   chapters   – AAP,   AAFP,   ACP
• Engaging   youth   and   families
– Build   leadership   among   youth   for   advocate   role
• Identifying   p   and   y   p
– Find   practices   working   on   HCT   or   willing   to   do   so
• Facilitating   a   QI   process
– Sponsor,   run,   support   a   learning   collaborative
• Meeting   MOC   Part   IV   requirements
PRACTICE   PERSPECTIVE:   HCT   PROCESSES
IMPACT   TO   YOUTH   OR   FAMILY
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• Tips   from   the   front   line   on   how   Title   V   programs   can   work   with   primary   care   community   to   improve   HCT
• Final   words   from   youth   and   p
– Parent   navigators/partners
– Mal   with   youth   perspective
‐
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• www.gottransition.org
• www.hrtw.org
• http://jaxhats.ufl.edu
• www.mahec.net/quality/chat.aspx?a=10
• Join   the   National   Health   Care   Transition
Center   on   Facebook   – search   GotTransition
• cooley@cmf.org
• ann.walls@gottransition.org
• AAP,   AAFP,   ACP:    A   Consensus   Statement   on   Health
Care   Transition   for   Young   Adults   with   Special   Health
Care   Needs.
Pediatrics,   2002,   110:6,   1304
• AAP,   AAFP,   ACP:    Clinical   Report—Supporting   the
Health   Care   Transition   From   Adolescence   to
Adulthood in the Medical Home Pediatrics July
2011
• White,   PH.
Destination   known:    Planning   the   transition   of   youth   with   special   health   care   needs   to   adult   care.
Adolescent   Health   Update,   2009,   21:3
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