Care Coordination Clinical Trial
Official title:
Implementing a Randomized Care Coordination Intervention for Minority Youth With Special Health Care Needs During Health Care Transition From Pediatric to Adult Health Care.
Special opportunities exist in vulnerable populations with chronic conditions to better understand what life course factors can facilitate attainment of optimal health and development. One such opportunity arises in the life of an adolescent or young adult when they transition their care from pediatric to adult health providers and systems, referred to as "health care transition". Experts generally agree that health care transition is often unsuccessful and associated with a variety of adverse outcomes. Adverse outcomes of unsuccessful health care transition include foregone or delayed medical care and having no identified adult medical home after leaving pediatrics. This foregone and delayed care can result in potentially preventable costly utilization of hospital emergency and inpatient services. Particularly concerning is increasing evidence that for some youth, transition from pediatric to adult medical care is a high-risk period for mortality. In addition to the adverse effects on individuals, unsuccessful health care transition also likely has economic consequences, particularly given that the majority of health care spending is already allotted to individuals with chronic conditions. These problems are even greater for low income and minority youth, with the District of Columbia having the highest level of unmet transition needs in the U.S.
Special opportunities exist in vulnerable populations with chronic conditions to better
understand what life course factors can facilitate attainment of optimal health and
development. One such opportunity arises in the life of an adolescent or young adult when
they transition their care from pediatric to adult health providers and systems, referred to
as "health care transition". Experts generally agree that health care transition is often
unsuccessful and associated with a variety of adverse outcomes. Adverse outcomes of
unsuccessful health care transition include foregone or delayed medical care and having no
identified adult medical home after leaving pediatrics. This foregone and delayed care can
result in potentially preventable costly utilization of hospital emergency and inpatient
services. Particularly concerning is increasing evidence that for some youth, transition from
pediatric to adult medical care is a high-risk period for mortality. In addition to the
adverse effects on individuals, unsuccessful health care transition also likely has economic
consequences, particularly given that the majority of health care spending is already
allotted to individuals with chronic conditions. These problems are even greater for low
income and minority youth, with the District of Columbia having the highest level of unmet
transition needs in the U.S.
In light of these facts, it becomes urgent to implement recommended standards for health care
transition and evaluate their impact on transition outcomes. This research quantifies the
impact of recommended health care transition practices using a randomized trial design and
analysis following the intention-to-treat paradigm. The investigators do so by comparing
aspects of 1) health care transition effectiveness (i.e., care coordination, timing, and
services received); 2) experience of care (i.e., satisfaction and quality of chronic illness
care); and 3) health care utilization in a population of 18-22 year-old African-American
adolescents with special health care needs, receiving primary care in an urban academic
adolescent medicine practice, using standardized outcome measures. Half of participants
received usual care enhanced by written transition information, and half received a health
care transition intervention modeled on the joint American Academy of Pediatrics, the
American Academy of Family Physicians, and the American College of Physicians best practices
report, released July 2011 that identified six recommended core components for transition
programs. These include both practice based components (i.e. written transition policy,
transitioning youth registry, and transfer of care) and patient level components (i.e.
transition planning and completion). This report makes available an important standard for
establishing transition practices but also demands careful evaluation.
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