Background: An estimated 750,000 youth with special health care needs enter adulthood each year. [1] Disease populations that once died in childhood now live into adulthood. Increased survival is celebratory but comes at a cost, because the young adult years in patients with chronic childhood conditions are often complicated by deteriorations in health. Worse health places increased demands on the healthcare system, particularly high utilization of emergency and inpatient services. [2, 3, 4] In addition, transfer from pediatric to adult care is often uncomfortable for patients; inpatient stays are cited by patients as one of the most negative aspects of transfer to adult care. [5]Physicians also are uncomfortable with the transfer to adult care. Forty percent of internal medicine (IM)-trained hospitalists reported feeling uncomfortable caring for patients with childhood-onset chronic disease (COCD), despite more than 60% of them caring for such patients on a routine basis. The IM group reported discomfort due to lack of familiarity with the literature and insufficient training in COCD and adolescent development. [6] Hospitalists caring for this population play a critical role in the integration into adult medical care, and may assist outpatient providers in transition efforts. In particular, hospitalists trained in Internal Medicine and Pediatrics offer a unique skill set to care for these patients, helping to bridge the gap between pediatric and adult medical care.
Purpose: We implemented a Med-Peds (MP) service line within general adult hospital medicine for the care of young adults with COCD. Each rounding attending is trained in Internal Medicine and Pediatrics in an effort to align training and comfort of providers with the patients. Our specific aims were: (1) to obtain baseline data about the population in order to understand opportunities for future interventions, and (2) to initiate patient-centered transition of care services for inpatients on the MP service line.
Description: The MP service line began in June 2019. During the first 24 weeks, 115 patients have been cared for on the line, accounting for 180 discharges. The average age was 26 years (18-44 years) and patients, on average, had 6.4 admissions during the last two years. Among these patients, 45% were insured with Medicaid, 26% with Medicare, 22% with private insurance, and 7% were uninsured. Common diagnoses included type 1 diabetes, sickle cell anemia, inflammatory bowel diseases, asthma, and rheumatologic disorders. The Transition Readiness Assessment Questionnaire (TRAQ), a 20-item validated tool for patients to self-report their level of preparation to transition to adult medical care, has been administered to 66% of patients. Hospitalists used those patient-reported responses to guide teaching on specific self-management skills essential for success in adult medical care. Additional structured approaches to assist with transition planning were implemented, including coordination of post-discharge transition to adult primary/specialty care providers and use of a transition-focused discharge summary.
Conclusions: Our early data supports the feasibility of a MP inpatient service line. This model allows MP hospitalists to care for young adults with common COCD, many of whom are high hospital utilizers, and provides a means to offer transition services. We expect that an inpatient service model focused on the special challenges faced by young adults with COCD will facilitate high quality transitions of care from pediatric to adult care.