The Transition Care Index: Standardizing comprehensive transition and transfer for young adults with inflammatory bowel disease

TL;DR

This paper introduces a standardized care index to improve transition and transfer for young adults with inflammatory bowel disease, aiming to reduce adverse outcomes.

Contribution

The novel contribution is the development and implementation of the IBD Transition Care Index to standardize transition processes and reduce variability in care.

Findings

The mean percentage of TCI variables completed increased from 62% to 71% post-intervention.

Patients under general GI physicians showed significant improvements in TCI completion and annual visit attendance.

Abstract

In young adults with inflammatory bowel disease (IBD), the time following transfer to adult care is high‐risk for adverse outcomes. We used quality improvement (QI) methods to standardize care, decrease variation, and improve preparation of young adults during the transition/transfer process.

We created the IBD Transition Care Index (TCI), a list of 10 variables whose completion was felt to represent a more comprehensive transition/transfer process. Variables were organized into three domains: Disease Control/Physical Health, Psychosocial Well‐being, and Transition/Transfer Preparation. We educated patients, caregivers, and providers on the value of completing the TCI to deliver complete, multidisciplinary preparation. We recorded variable completion in a database, reviewed results regularly with providers, and compared rates of variable completion between IBD‐focused and general gastroenterology (GI) physicians.

Three hundred twenty‐two patients transferred to adult care during the project period (211 pre‐intervention and 121 post‐intervention). In the overall cohort, the mean percentage of TCI variables completed increased from a baseline of 62%–71% in the post‐intervention period, with a significant increase in the rate of multidisciplinary IBD annual visit (IBD AV) attendance (51% vs. 62%, p = 0.03). Patients cared for by general GI physicians had significantly increased rates of both overall TCI variable completion (54% vs. 72%, p = 0.02) and IBD AV attendance (34% vs. 57%, p = 0.02) in the pre‐ versus post‐intervention period.

Care Indexes such as the TCI can be used to reduce variability and standardize complex clinical processes like transition/transfer for young adults with IBD, with the goal of improving patient outcomes.

Transition and transfer are inevitable processes for adolescents and young adults (AYAs) with chronic diseases like inflammatory bowel disease (IBD), yet preparation for transition is variable and often, absent.Patients with IBD are known to be at risk for poor adherence, increased disease activity, and need for unplanned care in the months following transfer to adult IBD care.

Transition and transfer are inevitable processes for adolescents and young adults (AYAs) with chronic diseases like inflammatory bowel disease (IBD), yet preparation for transition is variable and often, absent.

Patients with IBD are known to be at risk for poor adherence, increased disease activity, and need for unplanned care in the months following transfer to adult IBD care.

Using the IBD Transition Care Index, we identified variability in care and utilized interventions to standardize transition and transfer preparation across multiple domains and close practice gaps between IBD‐focused and general gastroenterology physicians.Standardizing transition and transfer across domains such as disease control/physical health, psychosocial well‐being, and transition and transfer planning/coordination has the potential to improve outcomes for AYAs during this clinically vulnerable time.

Using the IBD Transition Care Index, we identified variability in care and utilized interventions to standardize transition and transfer preparation across multiple domains and close practice gaps between IBD‐focused and general gastroenterology physicians.

Standardizing transition and transfer across domains such as disease control/physical health, psychosocial well‐being, and transition and transfer planning/coordination has the potential to improve outcomes for AYAs during this clinically vulnerable time.

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