Supporting Youth Transitions to Adult Primary Care

Mala Mathur, MD, MPH, a new faculty member in the Division of General Pediatrics and Adolescent Medicine, is leading a pilot quality improvement project that aims to better support youth as they transition from pediatric primary care to adult primary care.

The Importance of Health Care Transition

The project builds on interests that Dr. Mathur had while a staff pediatrician at Group Health Cooperative (GHC). There, she and a colleague developed workflows and electronic health record tools to help improve transitions of care for adolescent youth, especially those with special health care needs.

Dr. Mathur joined the department as a clinical associate professor in early 2017. She’s a member of the UW Health Transitions of Care Steering Committee and is excited that this topic is an organizational priority.

“Emerging literature suggests that during the pediatric to adult health care transition, there are often lapses in care, and changes in the way health care is administered, [that can result in] a decrease in the quality of care,” she explains. “This can be seen most in children with diabetes or chronic diseases---they don’t connect with providers or are lost to follow up.”

She notes that while the issue is important for all children, it’s particularly meaningful for children who have intellectual or developmental delays, or other special health care needs.

A policy statement from the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians offers guidance for clinicians as they support adolescents’ transition to an adult model of health care.

Preparing Youth and Families

Dr. Mathur’s project, which is supported by a grant from the Youth Health Transition Initiative at the Waisman Center, focuses specifically on readiness for health care transition.

Youth aged 12-26 who come for well visits at her practice at the UW Health University Station clinic, and at the practice of Christina Delgadillo, MD, at the UW Health 20 South Park clinic, will first receive a questionnaire that assesses their knowledge of their health care needs and their skills managing them.

They’ll also receive an educational handout with questions to ask during the transition process, helpful resources, and ways to practice independence.

“This can help families understand that transition is a process, we’re here to support them, and they may want to start working with their child now,” says Dr. Mathur. “It can also make youth aware of the things they need to know so they can feel comfortable accessing health care and taking care of their own medical needs.”

The team will measure which youth complete the readiness questionnaire and receive educational materials and counseling—and how those materials were perceived.

‘Meeting Families Where They Are’

Over the long term, Dr. Mathur hopes this work will help promote best practices for transition education throughout UW Health. Several of her Pediatrics colleagues are involved in similar efforts in their respective specialties.

For example, Ryan Coller, MD, MPH, focuses on when medically complex youth should transition from care at a children’s hospital to care at an adult hospital. Sheryl Henderson, MD, PhD, leads efforts to help youth with HIV transition to adult care. M. Tracy Bekx, MD, works to improve transitions of care for children with diabetes. And Dorota Walkiewicz-Jedrzejczak, MD, has an active transition clinic for children with inflammatory bowel disease.

“Transitions of care is so different than other QI processes because it is unique to every patient,”  reflects Dr. Mathur. “The challenge of helping youth transition is meeting families where they are.”