Strangers Headed to a Strange Land? A Pilot Study of Using a Transition Coordinator to Improve Transfer from Pediatric to Adult Services

Objective To compare the impact of a transition coordinator on outcomes for pediatric liver transplant recipients vs a historical comparison group. Study design To examine the utility of a transition coordinator, medication adherence, as measured by SDs of tacrolimus blood levels (Tacrolimus SD), wa...

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Bibliographic Details
Published in:The Journal of pediatrics 2013-12, Vol.163 (6), p.1628-1633
Main Authors: Annunziato, Rachel A., PhD, Baisley, Margaret C., BS, Arrato, Nicole, Barton, Codette, RN, Henderling, Fiona, RN, MSN, Arnon, Ronen, MD, Kerkar, Nanda, MD
Format: Article
Language:English
Subjects:
adults
blood
drug therapy
Female
health services
Humans
Immunosuppressive Agents - therapeutic use
liver transplant
Liver Transplantation
Male
Medication Adherence - statistics & numerical data
patients
Pediatrics
Pilot Projects
Quality Improvement
quality of life
tacrolimus
Tacrolimus - therapeutic use
Transition to Adult Care - organization & administration
Transition to Adult Care - standards
Young Adult
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Summary:Objective To compare the impact of a transition coordinator on outcomes for pediatric liver transplant recipients vs a historical comparison group. Study design To examine the utility of a transition coordinator, medication adherence, as measured by SDs of tacrolimus blood levels (Tacrolimus SD), was compared between the “transition coordinator group” (20 transplant recipients transferred between 2007 and 2012) and comparison group for 1 year before and after transfer. Measures of health care management, quality of life, and acceptability were administered to the transition coordinator group as well. Results A repeated measures ANOVA was used to compare adherence values between the transition coordinator group and the comparison group. During the year before transfer, for the transition coordinator group, Tacrolimus SD was 1.98 (SD = 1.05) vs 3.25 (SD = 1.19) for comparison patients, F (1,25) = 4.77, P = .04. After transfer, levels remained stable for the transition coordinator group, Tacrolimus SD = 1.88 (SD = 1.57), but increased for comparison patients, Tacrolimus SD = 4.36 (SD = 0.99), F (1,25) = 6.99, P = .01. Psychosocial outcomes remained stable during the transfer period and acceptability was high. Conclusions Our findings, although limited by a small sample size, suggest that a transition coordinator is a promising method to improve this process.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2013.07.031