Background: National guidelines recommend that pediatric health systems have written policies or guidelines addressing their approach to the pediatric to adult healthcare transition (HCT). It is unclear how inpatient care should be communicated in these policies, if at all. This is especially relevant as there are an increasing number of adults with childhood-onset conditions being admitted to pediatric hospitals. We aimed to identify pediatric hospital policies or guidelines that address the inpatient care of adult patients and determine which elements related to HCT are included.
Methods: HCT experts conducted a cross-sectional analysis of pediatric hospital policies that addressed inpatient care of adults existing in 2019 using convenience sampling via professional connections and online platforms. To evaluate the policies, HCT experts created a 40-item rubric (Table 1) through an iterative process informed by validity evidence from the six core elements of HCT and a published inpatient transition framework. Four independent reviewers evaluated de-identified policies using the rubric. We assessed rubric inter-rater reliability with percent agreement. We calculated the proportion of policies with each rubric component. We used a thematic analysis to examine policy content not captured by the rubric.
Results: Ten policies were submitted for review. Inter-rater reliability varied by rubric component (Table 1). Determining if a policy addressed HCT had the lowest percent agreement (69.4%) amongst HCT experts, and 40% of policies did not mention HCT at all. Age was mentioned in all ten policies. Only 6 rubric components were present in most policies: addressing HCT, patient characteristics (age, diagnosis, complexity), and availability of an adult acute care facility or subspecialists. All policies included varied age cut offs which ranged from 19 to 35 years old. Thematic analysis highlighted two additional components: differences between complexity of diagnoses and acute illness severity, and completion of hospitalization regardless of age for the duration of an admission (e.g., no transfer unless specific indication).
Conclusions: Pediatric hospital transition policies or guidelines describing pediatric to adult transition are scarce and have varying components present. Next steps include developing consensus on a standardized inpatient pediatric to adult health care transition guideline to facilitate a smooth transition into adult healthcare systems.
