FP32-5 Quality Improvement: Transition of care for adolescents with diabetes from pediatric to adult providers

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP32-Health Outcomes & Quality Improvement
Monday, June 17, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 11:05 AM
Room 301 (Moscone Center)

Poster Board MON-281
Sarah K Lyons*1, Marilyn Clougherty1, Selma Feldman Witchel1 and Mary T Korytkowski2
1Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, 2University of Pittsburgh Medical Center, Pittsburgh, PA
Background:  Diabetes (DM) control and clinic attendance have been reported to decline in adolescents during the transition from pediatric to adult care. To address these issues, we have implemented a transition program to maintain continuity of DM care as a quality improvement initiative.

Methods:  As part of the transition program, adolescents ready for transition are scheduled to see an endocrinologist and a certified diabetes educator in the adult DM center prior to departure from the pediatric endocrinology center.  They also receive a welcome letter and informational brochure.  Effectiveness of the program is evaluated by determining the time to the first adult appointment, and by comparing the frequency of visits, A1C, body mass index (BMI), blood pressure (BP), and total cholesterol (TC) for the 12 months preceding and following transition.  Satisfaction with the transition process is evaluated through patient questionnaires.  Patients who had transitioned to the adult DM center during the two years preceding the establishment of this transition program were selected as a control group.

Results:  Data was available on seven intervention (57% male) and seven control patients (43% male).  Two (intervention) patients have not returned for follow up due to attendance at out of state colleges. One (intervention) patient has T2DM.  No group differences were observed for age at transition (intervention vs. control: 19.8 vs. 20.1 years, p=0.48), time to first adult visit (2.7 vs. 2.9 months, p=0.90), or A1C (7.2% vs. 8.7%, p=0.06).  Within both groups, no significant differences in glycemic and metabolic measures (number of clinic appointments, A1C, BMI, BP and TC) were observed for the 12 months preceding and following transition.  Even in this small number of subjects, there was a trend for lower A1C in the intervention group. To date, patient satisfaction surveys have been completed by one intervention patient and two control patients with higher satisfaction by the intervention patient.

Discussion:  Initiation of a transition program is a key step to improve the healthcare needs for adolescents with DM.  While the number of patients included in this program is small, it is encouraging that clinic attendance and DM outcomes (A1C, BP, and TC) have not deteriorated for those who have chosen to transition within the university pediatric and adult DM care centers.  Data regarding additional patients with attention to satisfaction scores is being obtained.

Disclosure: MTK: Principal Investigator, Sanofi, Consultant, Regeneron, Speaker, American Association of Clinical Endocrinologists. Nothing to Disclose: SKL, MC, SFW

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm