Children's Mercy Recognized as Leader in Pediatric-to-Adult Transitional Care Approach

(From left) Dr. Karen Cox, Dr. Ann Modrcin and Terri Hickam.

The out-front position Children’s Mercy has staked by establishing a formal, hospital-wide program to transition pediatric patients to adult health care is attracting outside attention and generating requests to share the experience as a model for other institutions.

Children’s Mercy staff members Ann Modrcin, MD, EMBA, Division Director-Rehabilitation Medicine and Medical Director of Transition; Terri Hickam, MSW, LCSW, LSCSW, ACSW, CCM, Transition Program Manager; Karen Cox, PhD, RN, Executive Vice President/Chief Operating Officer; along with Patience White, MD, MA, and Margaret McManus, both of the National Alliance to Advance Adolescent Health and co-directors of the Center for Health Care Transition, authored a Guest Editorial in the February 2018 issue of the publication "Health & Social Work."

The editorial, titled, “Implementing a Nationally Recognized Pediatric-to-Adult Transitional Care Approach in a Major Children’s Hospital,” summarizes how Children's Mercy implemented a system-wide approach for transitioning to adult health care. Dr. White, a pioneer advocate of transition, urged Children's Mercy to participate in writing the editorial.

“She wanted to involve us because of our efforts, not just in doing a transition program, but a hospital-wide transition program,” Dr. Modrcin said. “We’re the only hospital in the country to do that.”

Since adopting transition as a strategic initiative in 2013, 14 divisions and 28 programs at Children's Mercy (more than half of the hospital) have adopted a standardized annual transition planning process using a national model incorporating the "Six Core Elements of Health Care Transition” from the Center for Health Care Transition Improvement. The elements include Transition Policy, Transition Tracking and Monitoring, Transition Readiness, Transition Planning, Transfer of Care, Transfer Completion. These elements are used to evaluate progress toward implementing successful transitions.

“Last year we had a 500 percent increase in the number of patients touched by our transition program,” Dr. Modrcin said, adding that the hospital currently has 10,500 patients over age 18 in our care, representing over 35,000 visits. These are patients targeted for transitioning to adult care.

“Our transition policy is that they should be successfully transitioned by their 22nd birthday,” Dr. Modrcin said. Currently Children's Mercy has about 1,200 patients over 22 who are still averaging two to three visits a year.

Children's Mercy continues to work toward the goal of 100 percent participation in the transition program.

“We’re not there yet, but we’re working on it!” Dr. Modrcin said. “From the very beginning we’ve said, ‘We’re going to transition all of our eligible patients; they deserve the attention required to make sure they enter the adult health care world with a plan.’ The literature shows that if patients aren’t transitioned well, especially those with special health care needs, their medical costs escalate, their complication rates increase and there are delays in addressing conditions that could be deadly. It’s a population at risk if we don’t do it well.”

Role model

Children's Mercy is embracing its position as a role model in adopting a formal transition planning process.

“We’re trying to be leaders in encouraging the conversation and building the infrastructure to make it as easy as possible to be successful,” Terri said. “We’re eager to share what we’ve learned in developing a transition planning process with distinct goals that patients, parents and providers need to accomplish.”Children’s Mercy is working with Got Transition and several other organizations on a collaborative article designed to help institutions implement transition planning by using this process. “We were invited to participate in that article because they really want to see our model duplicated elsewhere,” Terri said.

Key components

Key components of the transition program include: pre-visit planning reports that identify qualifying patients who need an annual transition conversation and an electronic questionnaire that patients complete to assess their transition readiness and set transition goals. Each division also receives monthly reports to help track their success and look for opportunities to improve.

Input in developing the transition program has been and continues to be provided by groups such as the Family Advisory Board and Teen Advisory Board, and the roles of nursing, care assistants, social work and executive support have been essential to the initiative.

“Every clinic may have a slightly different work flow process, but in every case, the success of the transition work depends upon the efforts of the nursing staff,” Dr. Modrcin said.

The program also has been supported by senior leadership, including executive sponsors Dr. Cox and David Westbrook, Senior Vice President-Strategy and Innovation. A Transitioning to Adult Health and Support Services Policy has been ratified by hospital administration.

“Transitioning our patients to adult health care is emotionally and logistically challenging, but it is one of our most important responsibilities,” Dr. Cox said. “Being recognized as a model for pediatric hospitals across the country demonstrates our commitment to doing the right thing for our children.”

Learn more about the Transition Program at Children's Mercy.