For adolescents and young adults who have chronic conditions, the transition from pediatric to adult medical care can be challenging given the lack of structural support in the health care system. The Improving Pediatric to Adult Care Transition (ImPACT) program was launched at Children’s Hospital Colorado in 2021 to help these patients navigate the health care system during their transition to adult care, according to quality improvement project outcomes presented at the National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care held March 15 to 18, 2023, in Orlando, Florida.

In 2020, co-directors of the program Jennifer A. Disabato, DNP, CPNP-PC, AC, and William C. Anderson, III, MD, of the Children’s Hospital Colorado and University of Colorado Anschutz Medical Campus performed a comprehensive needs assessment to identify gaps in care during the pediatric-to-adult transition. This needs assessment formulated the goals of ImPACT: to educate patients and promote engagement among stakeholders, to customize and streamline the transition of care, and to build a sustainable model for transition that can be used system-wide. To do so, the ImPACT Navigation Hub (INH), an interdisciplinary coaching and consulting team comprising a registered nurse (RN) coordinator, social worker, family navigator, and adult medicine and pediatric physicians was formed.

Figure. Process to support pediatric-to-adult health care transition for complex patients. Reprinted with permission from Disabato et al.

The ImPACT program was launched during the fourth quarter of 2021 and began its process in collaboration with bariatric surgery, congenital heart disease, solid organ transplant, and rheumatology clinics. In phases, the program partnered with a total of 16 clinics through the first quarter of 2023, including spinal cord injury, urology, neurology, endocrinology (the Turner Syndrome Clinic), irritable bowel syndrome, and the Breathing Institute, among others.


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The roll-out process of ImPACT comprised 6 weeks of education and 4 months of working together on joint referrals to adult care, followed by 6 months of focused team coaching and ongoing mentoring. The INH team facilitated a total of 66 referrals between 2021 and 2023, of which 31 have been completed, 24 are in process, and 11 are pending.

Overall, the ImPACT design of coaching and team support in phases allowed for the customization of transition tools for each clinic. The direct patient referrals to adult care by the INH team serve as documentation of the program’s success.

“Pediatric-focused NPs are ideally suited to be leaders in the implementation of system-based approaches to address the needs of this challenging and vulnerable patient population,” according to Dr Disabato.

In the future, the program will include patient and family satisfaction evaluations, continued expansion to other pediatric specialty clinics, and formalizing the transition champion role for individual clinics.

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Source

Disabato JA, Anderson WC. The Improving Pediatric to Adult Care Transition (ImPACT) Program: A Novel Approach to Support Adolescents, Families, Providers and Teams. Presented at: NAPNAP National Conference; March 15-18, 2023; Orlando, FL.