The process of transition from pediatric to adult diabetes care: recommendations for US healthcare systems

2015 ◽  
Vol 5 (5) ◽  
pp. 379-391 ◽  
Author(s):  
David V Wagner ◽  
Jenae Ulrich ◽  
Ines Guttmann-Bauman ◽  
Danny C Duke
Keyword(s):  
Diabetes Care ◽  
Healthcare Systems ◽  
Adult Diabetes

scholarly journals The Transition From Pediatric to Adult Diabetes Care Services

2013 ◽  
Vol 27 (3) ◽  
pp. 132-145 ◽  
Author(s):  
Kathleen M. Hanna ◽  
Jason Woodward
Keyword(s):  
Diabetes Care ◽  
Care Services ◽  
Adult Diabetes

scholarly journals Transition from pediatric to adult diabetes care: smooth or slippery?

2010 ◽  
Vol 11 (1) ◽  
pp. 24-27 ◽  
Author(s):  
Carine de Beaufort ◽  
Przemyslawa Jarosz-Chobot ◽  
Marcia Frank ◽  
Jennifer de Bart ◽  
Grazyna Deja
Keyword(s):  
Diabetes Care ◽  
Adult Diabetes

scholarly journals Testing an audit and feedback-based intervention to improve glycemic control after transfer to adult diabetes care: protocol for a quasi-experimental pre-post design with a control group

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Rayzel Shulman ◽  
Ian Zenlea ◽  
Baiju R. Shah ◽  
Cheril Clarson ◽  
Jennifer Harrington ◽  
...  
Keyword(s):  
Young Adults ◽  
Glycemic Control ◽  
Diabetes Care ◽  
Audit And Feedback ◽  
System Level ◽  
Pediatric Diabetes ◽  
Patient Reported ◽  
Quasi Experimental ◽  
Adult Diabetes

Abstract Background When young adults transfer from pediatric to adult diabetes care they are at risk for deterioration of glycemic control, putting them at an increased risk of developing both acute and chronic complications. Despite increased awareness of these risks, there are gaps in care delivery during this vulnerable time and variability in the implementation of recommended transition practice. Audit and feedback (AF) interventions have a positive but variable effect on implementation of best practices. An expert group identified specific suggestions for optimizing the effectiveness of AF interventions. We aim to test an AF-based intervention incorporating these specific suggestions to improve transition practices and glycemic control in the first year after transfer from pediatric to adult diabetes care. Methods This is a pragmatic quasi-experimental study; a series of three cohort studies (pre-implementation, early-implementation, and post-implementation) to compare the baseline adjusted hemoglobin A1c (HbA1c) in the 12 months after the final pediatric visit in five pediatric diabetes centres within the Ontario Pediatric Diabetes Network in Ontario, Canada. The intervention includes three components: 1) centre-level feedback reports compiling data from chart abstraction, linked provincial administrative datasets, and patient-reported experience measures; 2) webinars for facilitated conversations/coaching about the feedback; and 3) online repository of curated transition resources for providers. The primary outcome will be analyzed using a multivariable linear regression model. We will conduct a qualitative process evaluation to understand intervention fidelity and to provide insight into the mechanisms of action of our results. Discussion There is a need to develop an innovative system-level approach to improve outcomes and the quality of care for young adults with type 1 diabetes during the vulnerable time when they transfer to adult care. Our research team, a collaboration of health services, implementation science, and quality improvement researchers, are designing, implementing, and evaluating an AF-based intervention using recommendations about how to optimize effectiveness. This knowledge will be generalizable to other care networks that aim to deliver uniformly high-quality care in diverse care settings. Trial registration ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

scholarly journals An algorithm to identify medication nonpersistence using electronic pharmacy databases

2015 ◽  
Vol 22 (5) ◽  
pp. 957-961 ◽  
Author(s):  
Melissa M Parker ◽  
Howard H Moffet ◽  
Alyce Adams ◽  
Andrew J Karter
Keyword(s):  
Healthcare Systems ◽  
Healthcare Operations ◽  
Timely Manner ◽  
Pharmacy Records ◽  
Grace Period ◽  
Adult Diabetes ◽  
Primary Nonadherence ◽  
Medication Taking Behavior ◽  
Novel Algorithm

Abstract Objective Identifying patients who are medication nonpersistent (fail to refill in a timely manner) is important for healthcare operations and research. However, consistent methods to detect nonpersistence using electronic pharmacy records are presently lacking. We developed and validated a nonpersistence algorithm for chronically used medications. Materials and Methods Refill patterns of adult diabetes patients (n = 14,349) prescribed cardiometabolic therapies were studied. We evaluated various grace periods (30-300 days) to identify medication nonpersistence, which is defined as a gap between refills that exceeds a threshold equal to the last days’ supply dispensed plus a grace period plus days of stockpiled medication. Since data on medication stockpiles are typically unavailable for ongoing users, we compared nonpersistence to rates calculated using algorithms that ignored stockpiles. Results When using grace periods equal to or greater than the number of days’ supply dispensed (i.e., at least 100 days), this novel algorithm for medication nonpersistence gave consistent results whether or not it accounted for days of stockpiled medication. The agreement (Kappa coefficients) between nonpersistence rates using algorithms with versus without stockpiling improved with longer grace periods and ranged from 0.63 (for 30 days) to 0.98 (for a 300-day grace period). Conclusions Our method has utility for health care operations and research in prevalent (ongoing) and new user cohorts. The algorithm detects a subset of patients with inadequate medication-taking behavior not identified as primary nonadherent or secondary nonadherent. Healthcare systems can most comprehensively identify patients with short- or long-term medication underutilization by identifying primary nonadherence, secondary nonadherence, and nonpersistence.

scholarly journals Looking forward to transition: perspectives on transition from pediatric to adult diabetes care

2013 ◽  
Vol 3 (4) ◽  
pp. 305-313 ◽  
Author(s):  
Jennifer K Raymond ◽  
Danny C Duke ◽  
Lisa Shimomaeda ◽  
Michael A Harris
Keyword(s):  
Diabetes Care ◽  
Adult Diabetes

scholarly journals Transitioning from Pediatric to Adult Diabetes Care

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Nicole Johnson ◽  
Stephanie Melton ◽  
Ashley Wingert
Keyword(s):  
Diabetes Care ◽  
Adult Diabetes
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