Automated Youth-To-Adult Transition Planning Using Health Information ...
Condition: Transition; Adolescent Behavior
Study type: Interventional

Summary: 
      This study seeks to automate the process of youth to adult transition using an existing
      computerized decision support system in primary care. Subjects will complete the TRAQ
      readiness questionnaire after the age of 14, and then their responses will be flagged for the
      physician to review and provide additional transition related educational materials. Once
      transition is necessary, the system sends an automated email to the responsible party in the
      office.
    

Detailed description: 
      This proposal seeks to improve transition care using health information technology. The
      process of transition from a pediatric to adult provider is a universal need across both
      primary care and subspecialties. Little work has been done specifically within pediatric
      gastroenterology to address the needs of patients with chronic gastrointestinal disease. The
      investigators propose to use an existing computerized clinical decision support system (CHICA
      - the Child Health Improvement through Computer Automation system) to pilot a youth-to-adult
      Transition module within a large primary care network. This will be accomplished by
      automating the "Six Core Elements of Healthcare Transition" set forth by the National Health
      Care Transition Center. These core elements consist of: (1) sharing the transition policy
      with families, (2) providing transition tracking and monitoring, (3) assessing transition
      readiness using a standardized tool (the TRAQ - Transition Readiness Assessment
      Questionnaire), (4) transition planning through iterative preparation of all necessary
      transition skills and documents, (5) accomplishing the transfer of care itself, and (6)
      assessing transfer completion. Each of these core elements will be accomplished using a
      combination of patient-facing (tablets) and providerfacing (webforms alongside the electronic
      medical record). Once these software rules are written and tested, they will be piloted in
      the existing primary care decision support system. The investigators will iteratively assess
      the following goals: (1) each patient's transition readiness as appropriate for their age,
      and (2) provider and patient satisfaction with the transition process. These outcomes will be
      compared in a prepost design, data will be collected during the first 6 months prior to the
      Transition module being implemented in CHICA. Following this 6-month period, the Transition
      module will be turned on, and a repeat assessment made of these outcomes. If this pilot test
      is successful, the investigators will then be ready to launch this module in a similar system
      (CHICA-GI) that will be live in the pediatric gastroenterology clinic. Once this system has a
      transition module active, the investigators will be able to test if it accomplishes similar
      goals for gastroenterology subspecialty patients, including disease-specific transition
      goals, in future R21 and R01 applications.
    

Intervention name(s): Automated transition care reminders
Intervention type(s): Behavioral
Intervention description(s): The CHICA system will gather the elements of the TRAQ questionnaire and report the specific areas of deficiency to the physician. If a patient reaches the point of care transition (18 years), then an automated email is sent to a clinic nurse.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment