250. Electronic Medical Record-Based Transition Planning Tool for Children & Youth With Special Health Care Needs: A Continuous Quality Improvement Project to Increase Provider Satisfaction and Preference

Purpose: Evidence-based methods to promote transition from pediatric to adult-based care for youth with special health care needs are needed. While the use of electronic medical record (EMR) based planning tools to facilitate transition by pediatric providers is promising, evidence that providers will use these tools is lacking. A health care transition (HCT) transition planning tool (TPT), designed to identify and help rectify gaps in knowledge/ skills needed by patients tomanage their disease in preparation for HCT from pediatric to adult care, was built into the EMR at a large children’s hospital. Use during the first 21 months (March 2012November 2013) was lower than expected as providers found the TPT 1.0 difficult to locate in the EMR and cumbersome to use. A streamlined, user-friendly upgrade from TPT 1.0 (TPT version 2.0) was introduced in December 2013. This quality improvement project will evaluate provider satisfaction with and preference for the improved TPT. Methods: Health care providers (physicians, nurses, social workers, and care navigators) working with 16-25 year-olds in four sub-specialty services (Cardiology, Hematology, Physiatry, and Retrovirology) consented to participate in a continuous quality improvement project to evaluate the implementation of an EMR-based TPT. Clinics volunteered because they serve youth who experience increased morbidity and mortality associated with inadequate transition from pediatric to adult health care. Providers were trained to use TPT 1.0 and received ongoing technical assistance. Using Plan-Do-Study-Act (PDSA) methods, feedback from providers prompted the development of TPT 2.0, which included the addition of a transition button on the EMR navigation pane, a flow sheet reporting the patient’s transition planning progress, and a simplified user interface with fewer clicks needed to access the tool. Providers (n1⁄417) completed a self-administered survey in November 2013 before TPT 2.0 was introduced and a second survey (n1⁄416) 7 months later (July 2014). Both surveys assessed TPT use, including barriers, and satisfaction with the TPT. In addition, the second survey asked providers to indicate which version (TPT 1.0 or TPT 2.0) they preferred. Results: Improved satisfaction was reported in ease of use (80% versus 67% for TPT 2.0 and 1.0, respectively) and accessibility of the tool (80% versus 58%), the summary page to help follow patients through the transition process (87% versus 73%), and the time it takes to utilize the tool in clinic (67% versus 42%). Despite taking less time to use, 63% (10/15) said they did not use TPT 2.0 as often as they wanted, citing time constraints in busy clinics as the primary reason. One clinic increased efficiency by assigning social workers to use the tool after clinic sessions. 100% of study providers stated they preferred using TPT 2.0 over TPT 1.0. Conclusions: In a group of providers motivated by the high morbidity and mortality associated with poor health care transition, there was increased satisfaction and preference for TPT 2.0, facilitated by incorporating their recommendations to improve the tool. Provider satisfaction and preference for this upgraded tool is expected to facilitate health care transition planning. Sources of Support: Funded by HRSA and Texas Department of State Health Services.