Reducing bottlenecks: professionals’ and adolescents’ experiences with transitional care delivery

BMC Health Services Research

Mathilde MH Strating³  AnneLoes van Staa²  Marij E Roebroeck¹  Henk M Sonneveld³  Jane M Cramm³  Anna P Nieboer³ 

[1] Department of Rehabilitation Medicine and Physical Therapy, Erasmus University Medical Centre, Rotterdam, The Netherlands;Centre of Expertise Innovations in Care, Rotterdam University, Rotterdam, The Netherlands;Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands

关键词: Adolescents;    Quality improvement programme;    Transition programme;    Transitional care;    Quality of care;    Bottlenecks;   

Others  :  1134202
DOI  :  10.1186/1472-6963-14-47

 received in 2013-06-28, accepted in 2014-01-30,  发布年份 2014

【 摘 要 】

Background

The purpose of this study was to describe the interventions implemented in a quality improvement programme to improve transitional care and evaluate its effectiveness in reducing bottlenecks as perceived by professionals and improving chronically ill adolescents’ experiences with care delivery.

Methods

This longitudinal study was undertaken with adolescents and professionals who participated in the Dutch ‘On Your Own Feet Ahead!’ quality improvement programme. This programme followed the Breakthrough Series improvement and implementation strategy.

A total of 102/128 (79.7%) professionals from 21 hospital teams filled out a questionnaire at the start of the programme (T0), and 79/123 (64.2%; five respondents had changed jobs) professionals completed the same questionnaire 1 year later (T1). Seventy-two (58.5%) professionals from 21 teams returned questionnaires at both time points. Of 389 and 430 participating adolescents, 36% and 41% returned questionnaires at T0 and T1, respectively. We used descriptive statistics and two-tailed, paired t-tests to investigate improvements in bottlenecks in transitional care (perceived by professionals) and care delivery (perceived by adolescents).

Results

Professionals observed improvement in all bottlenecks at T1 (vs. T0; p < 0.05), especially in the organisation of care, such as the presence of a joint mission between paediatric and adult care, coordination of care, and availability of more resources for joint care services. Within a 1-year period, the transition programme improved some aspects of patients’ experiences with care delivery, such as the provision of opportunities for adolescents to visit the clinic alone (p < 0.001) and to decide who should be present during consultations (p < 0.05).

Conclusions

This study demonstrated that transitional care interventions may improve the organisation and coordination of transitional care and better prepare adolescents for the transition to adult care within a 1-year period. By setting specific goals based on experiences with bottlenecks, the breakthrough approach helped to improve transitional care delivery for adolescents with chronic conditions.

【 授权许可】

   
2014 Nieboer et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]McDonagh JE, Kelly DA: The challenges and opportunities for transitional care research. Pediatr Transplant 2010, 14(6):688-700.
• [2]While A, Forbes A, Ullman R, Lewis S, Mathes L, Griffiths P: Good practices that address continuity during transition from child to adult care: synthesis of the evidence. Child Care Health Dev 2004, 30(5):439-452.
• [3]Rosen DS, Blum RW, Britto M, Sawyer SM, Siegel DM: Transition to adult health care for adolescents and young adults with chronic conditions: position paper of the society for adolescent medicine. J Adolesc Health 2003, 33:309-311.
• [4]Blum RW, Garell D, Hodgman CH, Jorissen TW, Okinow NA, Orr DP, Slap GB: Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the society for adolescent medicine. J Adolesc Health 1993, 14:570-576.
• [5]Fegran L, Hall EO, Uhrenfeldt L, Aagaard H, Ludvigsen MS: Adolescents’ and young adults’ transition experiences when transferring from paediatric to adult care. Int J Nurs Stud 2013. doi:10.1016/j.ijnurstu.2013.02.001
• [6]Crowley R, Wolfe I, Lock K, McKee M: Improving the transition between paediatric and adult healthcare: a systematic review. Arch Dis Child 2011, 96(6):548-553.
• [7]Nakhla M, Daneman D, Frank M, Guttmann A: Translating transition: a critical review of the diabetes literature. J Pediatr Endocrinol Metab 2008, 21:507-516.
• [8]Stewart D, Stavness C, King G, Antle B, Law M: A critical appraisal of literature reviews about the transition to adulthood for youth with disabilities. Phys Occup Ther Pediatr 2006, 26:5-24.
• [9]Lotstein DS, Seid M, Klingensmith G, Case D, Lawrence JM, Pihoker C, Dabelea D, Mayer-Davis EJ, Gilliam LK, Corathers S, Imperatore G, Dolan L, Anderson A, Bell RA, Waitzfelder B, SEARCH for Diabetes in Youth Study Group: Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence. Pediatrics 2013, 131(4):1062-1070.
• [10]Lugasi T, Achille M, Stevenson M: Patients’ Perspective on factors that facilitate transition from child-centered to adult-centered health care: a theory integrated metasummary of quantitative and qualitative studies. J Adolesc Health 2011, 48(5):429-440.
• [11]Kennedy A, Sawyer S: Transition from pediatric to adult services: are we getting it right? Curr Opin Pediatr 2008, 20(4):403-409.
• [12]Roebroeck ME, Jahnsen R, Carona C, Kent RM, Chamberlain MA: Adult outcomes and lifespan issues for people with childhood-onset physical disability. Dev Med Child Neurol 2009, 51:670-678.
• [13]Kirk S: Transitions in the lives of young people with complex healthcare needs. Child Care Health Dev 2008, 34(5):567-575.
• [14]McDonagh JE, Viner RM: Lost in transition? Between paediatric and adult services. BMJ 2006, 332(7539):435-436.
• [15]Binks JA, Barden WS, Burke TA, Binks JA, Barden WS, Burke TA, Young NL: What do we really know about the transition to adult-centered health care? A focus on cerebral palsy and spina bifida. Arch Phys Med Rehabil 2007, 88:1064-1073.
• [16]McLaughlin SE, Diener-West M, Indurkhya A, Rubin H, Heckmann R, Boyle MP: Improving transition from pediatric to adult cystic fibrosis care: lessons from a national survey of current practices. Pediatrics 2008, 121:e1160-e1166.
• [17]Grant C, Pan J: A comparison of five transition programmes for youth with chronic illness in Canada. Child Care Health Dev 2011, 37(6):815-820.
• [18]van Staa AL, Jedeloo S, van Meeteren J, Latour JM: Crossing the transition chasm: experiences and recommendations for improving transitional care of young adults, parents and providers. Child Care Health Dev 2011, 37(6):821-832.
• [19]van Staa AL, de Burgt AE ES-v, van der Stege HA, Hilberink SR: Transitie in zorg van jongeren met chronische aandoeningen in Nederland nog onder de maat. [Transition of care for young people with chronic conditions: substandard in the Netherlands.]. Tijdschr Kindergeneeskd 2010, 78(6):227-236.
• [20]Institute for Healthcare Improvement (IHI): The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. Boston: Institute for Healthcare Improvement; 2003. IHI Innovation Series white paper
• [21]Sonneveld HM, Strating MM, van Staa AL, Nieboer AP: Gaps in transitional care: what are the perceptions of adolescents, parents and providers? Child Care Health Dev 2013, 39(1):69-80.
• [22]Cramm JM, Strating MMH, Roebroeck ME, Nieboer AP: The importance of general selfefficacy for the quality of life of adolescents with chronic conditions. Soc Indic Res 2013, 113(1):551-561.
• [23]Cramm JM, Strating MMH, Sonneveld HM, Nieboer AP: The longitudinal relationship between satisfaction with transitional care and social and emotional quality of life among chronically ill adolescents. Appl Res Qual Life 2013, 8:481-491.
• [24]Cramm JM, Strating MMH, Sonneveld HM, Nieboer AP: Relationships between quality of life and satisfaction with care and self-efficacy in adolescents with diabetes. Child Indic Res. 6(3):593-604.
• [25]van Staa AL, Schoots JW: Op Eigen Benen Vooruit! Betere transitiezorg voor jongeren met chronische aandoeningen. Resultaten van het Actieprogramma Op Eigen Benen Vooruit! (2008–2012). [On Your Own Feet Ahead! Better transitional care for youth with chronic conditions. Results of the Action Programme On Your Own Feet Ahead! (2008–2012). Rotterdam: Hogeschool Rotterdam/Rotterdam University; 2012.
• [26]McDonagh JE, Southwood TR, Shaw KL: Growing up and moving on in rheumatology: development and preliminary evaluation of a transitional care programme for a multicentre cohort of adolescents with juvenile idiopathic arthritis. J Child Health Care 2006, 10(1):22-42.
• [27]Shaw KL, Southwood TR, McDonagh JE: Users’ perspectives of transitional care for adolescents with juvenile idiopathic arthritis. Rheumatology 2004, 43:770-778.
• [28]Shaw KL, Southwood TR, McDonagh JE: Development and preliminary validation of the ‘mind the gap’ scale to assess satisfaction with transitional health care among adolescents with juvenile idiopathic arthritis. Child Care Health Dev 2007, 33(4):380-388.
• [29]Betz CL, Lobo ML, Nehring WM, Bui K: Voices not heard: a systematic review of adolescents’ and emerging adults’ perspectives of health care transition. Nurs Outlook 2013, 61(5):311-336.
• [30]Braithwaite J, Runciman WB, Merry AF: Towards safer, better healthcare: harnessing the natural properties of complex sociotechnical systems. Qual Saf Health Care 2009, 18(1):37-41.
• [31]Schouten LM, Hulscher ME, van Everdingen JJ, Huijsman R, Grol RP: Evidence for the impact of quality improvement collaboratives: systematic review. BMJ 2008, 336(7659):1491-1494.
• [32]Cramm JM, Nieboer AP: High-quality chronic care delivery improves experiences of chronically ill patients receiving care. Int J Qual Health Care 2013, 25(6):689-695.
• [33]Cramm JM, Nieboer AP: In the Netherlands, rich interaction among professionals conducting disease management led to better chronic care. Health Aff (Millwood) 2012, 31(11):2493-2500.
• [34]Scholten L, Willemen AM, Last BF, Maurice-Stam H, van Dijk EM, Ensink E, Zandbelt N, van der Hoop-Mooij A, Schuengel C, Grootenhuis MA: Efficacy of psychosocial group intervention for children with chronic illness and their parents. Pediatrics 2013, 131:1196-2003.
• [35]van Staa AL, Jedeloo S, Latour JM, Trappenburg MJ: Exciting but exhausting: experiences with participatory research with chronically ill adolescents. Health Expectations 2010, 13(1):95-107.