Pediatric-to-Adult Transitions of Care

The DEI Shift's mission is to create a podcast series on diversity, equity, and inclusion (D.E.I.) in medicine that sparks discussion and provides practice-changing data and stories for a physician, student, allied health professional, and health care leader audience. Listeners will be able to gain useful information to improve their practices and environments, to gain empathy, cultural competency, and humility, and to learn more about emerging D.E.I. concepts. The DEI Shift will discuss issues related to gender, race, sexuality, religion, ability, socioeconomics, and so much more.

Co-Hosts: Dr. Pooja Jaeel, Dr. Maggie Kozman

Guests: Dr. Shirin Alonzo 

Editor/Assistant Producer: Joanna Jain, Clara Baek

Production Assistants: Alexandra Babakanian, Leyna Nguyen

Learning Objectives:

1. Define Healthcare Transitions.
2. Describe two barriers that patients and families face in transitioning to an adult-centered model of care.
3. Describe two barriers that healthcare professionals face in comprehensive transition.
4. Identify specific challenges that patients with complex medical needs face during the transition process.

Co-hosts’ Notice: Physician and provider are terms used interchangeably by many in the medical community. The DEI Shift podcast team endorses and supports the use of physician in place of provider where applicable as outlined in ACP policy.

[0:00-1:22] Introduction 

Introduction of our co-hosts, guest, and the episode topic.

[1:22-2:31] Introducing Guest Dr. Shirin Alonzo

• Dr. Shirin Alonzo
  • Meds/Peds primary care physician with a neurodevelopmental specialty
    • Focus on special needs and complex care pediatric conditions
  • Masters of public health with focus on family and community health

[2:31-5:01] “A Step in Your Shoes” Segment

[5:01-11:05] Transitions of Care Definitions

• Transitions of care from the pediatric to the adult health care system
  • Defined by the Society of Adolescent Medicine as the purposeful, planned movement from a child to adult oriented healthcare system to provideuninterrupted, coordinated, developmentally appropriate, psychologically sound and comprehensive healthcare
• Challenges in consistency and clarity about defining patients who are medically fragile
  • Defined by the Federal Maternal and Child Health Bureau as children at increased risk for or have a chronic physical, developmental, behavioral, or emotional condition
  • Defined medically as non-ambulatory patients with conditions that warrant 24 hour nursing care

[11:05-20:05] Challenges Regarding Transitions of Care for Medically Fragile Populations

• No single definition for medically fragile patients
  • Without standard metrics and definitions, goals cannot be established
  • Differences can vary based on patient needs and physician expertise
• Patients are more complex and require many medical, social, and financial needs
  • Need physician awareness about public and private assistance and resources
• Parental awareness, knowledge, and integration into the care team
  • Parents of children with special needs have valuable insight into their condition
• Complicated financial considerations due to certain qualifications related to disabilities
  • Qualifications change and differ based on age, rather than considering what is developmentally appropriate for the patient and their condition

[20:05-22:06] Six Core Elements of Health Care Transition

• Six Core Elements of Health Care Transition
  • Approach that identifies the components of a successful transition from a youth-centered model of health care to an adult-centered model of health care and proposes steps one can take to implement the transition
  • Model highlighted in a 2018 clinical report co-sponsored by ACP, AFP, and AAP
• Current status of implementing this approach to health care
  • Raising awareness, not yet at the implementation phase
    • Financial structure may be a hindrance
    • Without financial reimbursement or a metric for measuring how effective a transition of care is, there is a lack of incentive to implement improvements in transitions of care

[22:06-26:09] Improving Transitions of Care on an Individual Level

• Evaluate your current health care system, regardless of your current training level
• Advocate for your patients
  • Understand the system, recognize gaps, propose solutions for change
• Learn from your patients and their parents
  • Parents have gained valuable insight into resources that you can share with other patients
• Teach others, encourage patient advocacy
• Network with people who share the same goals and values as you

[26:09-29:18] Inspiring Trainees to Care For Medically Complex/Fragile Populations

• Lack of experience and appropriate training leads to some being afraid of providing care to these populations
• Need for inspiring trainees to care for those who are medically complex/fragile
• Mandating complex care training, like geriatrics training, can contribute to a solution

[29:18-32:30] Learning About the Healthcare System and Health Insurance

• Health insurance can be overwhelming, but you don’t need to be an expert to make a change
• Network with people who have experience in what you are interested in
• Learn about our current healthcare system from experiences, building connections, doing research, and being transparent about what you don’t know

[32:30-33:35] Change Starts with You

• Change starts with you and your patient
• Connect with your patients’ parents
• Change can only happen when physicians, patients, and parents work together

[33:35-34:54] Closing

[34:54-36:12] Outro

• Twitter and Instagram: @TheDEIshift
• Email: thedeishift@gmail.com
• Website: www.thedeishift.com

Other resources:

• NCHS 2020 Report on Children with Special Healthcare Needs
• Overview of CCS Eligible Medical Conditions

Credits:

Guest: Dr. Shirin Alonzo 

Co-hosts/Producers: Dr. Pooja Jaeel, Dr. Maggie Kozman

Executive Producer: Dr. Tammy Lin 

Co-Executive Producers: Dr. Pooja Jaeel, Dr. Tiffany Leung

Senior Producers: Dr. Maggie Kozman, Dr. DJ Gaines

Editor/Assistant Producer: Joanna Jain, Clara Baek

Production Assistants: Alexandra Babakanian, Leyna Nguyen

Website/Art Design: Ann Truong

Music: Chris Dingman

Contributors

Maggie Kozman, MD, ACP Member – Co-Host

Pooja Jaeel, MD, ACP Member – Co-host

Shirin Alonzo, MD - Guest   

Joanna Jain - Editor/Assistant Producer

Clara Baek - Editor/Assistant Producer

Alexandra Babakanian, - Production Assistant

Leyna Nguyen - Production Assistant

Tiffany I. Leung, MD, MPH, FACP, FAMIA, FEFIM – Co-Executive Producer

Tammy Lin, MD, MPH, FACP – Co-Executive Producer

DJ Gaines, MD, ACP Member – Sr. Producer

Reviewers

Tammy Lin, MD, MPH, FACP

Tiffany I. Leung, MD, MPH, FACP, FAMIA, FEFIM

None of the contributors or reviewers for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Release Date: June 15, 2022

Expiration Date: June 15, 2025

CME Credit

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and the DEI Shift.  The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The American College of Physicians designates each enduring material (podcast) for 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM Maintenance of Certification (MOC) Points

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to .5 medical knowledge MOC Point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.  Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

How to Claim CME Credit and MOC Points

After listening to the podcast, complete a brief multiple-choice question quiz.  To claim CME credit and MOC points you must achieve a minimum passing score of 66%.  You may take the quiz multiple times to achieve a passing score.