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

• 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
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2013.07.031

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.