TABLE 2

Transition Intervention Measures, Categorized in the Framework of the Triple Aim

AuthorExperience of Care MeasuresPopulation Health MeasuresCost Measures
Annunziato et al 201327None assessedAdherence to care/guidelinesNone assessed
 ○ Tacrolimus SD↑*
Patient-reported outcome measures
 ○ 36-Item Short Form Health Survey
Self-care skills
 ○ Developmentally Based Skills Checklist
Bent 200246None assessedPatient-reported outcome measuresCost
 ○ The London Handicap Scale↑*
 ○ Nottingham Health Profile
 ○ The Barthel Index↑* ○ Services and staff (estimated)
 ○ Euroqol Visual Analog Scale
 ○ Rosenberg Self-Esteem Scale
 ○ Proactive Attitude Scale
 ○ Perceived Stress Scale
 ○ General Self-Efficacy Scale
Betz et al 201044None assessedPatient-reported outcome measuresNone assessed
 ○ Personal Adjustment and Role Skills Scale III
Self-care skills
 ○ Denyes Self-Care Practice Instrument
 ○ Community Life Skills Scale
Blaauwbroek et al 200839None assessedPatient-reported outcome measuresNone assessed
 ○ 36-Item Short Form Health Survey
Boyle et al 200137None assessedPatient-reported outcome measuresNone assessed
Transition concernsa↑*
Brotzman et al 200134None assessedAdherence to care/guidelinesCost
 ○ Treatment cost per patient
 ○ Appropriate use of DemerolUtilization
 ○ Appropriate use of hydroxyurea ○ Inpatient days
 ○ Emergency department visits
Cadario et al 200915SatisfactionAdherence to care/guidelinesGaps in care
 ○ Rated transition as good/sufficient/bad↑* ○ Foot examination/y↑* ○ Time between last pediatric and first adult visit↑*
 ○ Rated pediatric DM service as good/sufficient/bad ○ Microalbuminuria screening/y↑*Utilization
 ○ HbA1C monitoring/y↑* ○ Visits per year↑*
 ○ Eye assessments/y↑* ○ Clinic attendance in pediatric DM service
Disease-specific measure ○ Clinic attendance in adult DM service↑*
 ○ HbA1C in pediatric clinic ○ Accessed specialist care↑*
 ○ First HbA1C after transfer to adult clinic
 ○ HbA1C after 1 y in adult clinic↑*
 ○ Variation of HbA1C after 1 y in adult clinic↑*
Chaturvedi et al 200928None assessedDisease-specific measureUtilization
 ○ Creatinine ○ Inpatient days
 ○ Acute rejection episodes ○ Attendance at scheduled appointments
Chaudhry et al 201238SatisfactionPatient-reported outcome measuresNone assessed
○ Satisfaction in pediatric programa↑* ○ Perceived health statusa↑*
○ Satisfaction in adult programa ○ Independencea
○ Physician consideration of patient opiniona↑* ○ Anxietya
Cuttell et al 200516None assessedSelf-care skillsNone assessed
 ○ DM knowledgea
Dabadie et al 200843SatisfactionSelf-care skillsNone assessed
○ Perception of transitiona ○ Attending visits alone
Gholap et al 200617None assessedAdherence to care/guidelines (only measured in patients with DM >7 y)Utilization (measured in all patients with DM)
 ○ Screening for hypertension↑* ○ Clinic attendance
 ○ Screening for nephropathy↑*
Disease-specific Measure (only measured in patients with DM >7 y)
 ○ HbA1C↑*
 ○ Hypertension
 ○ Nephropathy↑*
 ○ Retinopathy
Gilmer et al 201242None assessedNone assessedUtilization
 ○ Outpatient visits↑*
 ○ Emergency department visits
 ○ Inpatient admissions
Gleeson et al 201340None assessedNone assessedGaps in care
 ○ Loss to follow-up within 3 years of transfer
Utilization
 ○ Attendance at first 2 adult appointments
Hankins et al 201235None assessedNone assessedUtilization
 ○ Completed first visit with an adult provider↑*
Harden et al 201245None assessedDisease-specific measureNone assessed
 ○ Kidney transplant losses
 ○ Rates of acute rejection of kidney transplant
Mortality
Holmes-Walker et al 200718None assessedDisease-specific measureUtilization
 ○ HbA1C↑* ○ DKA hospital admissions↑*
 ○ DKA hospital readmissions
 ○ Length of stay of admissions
 ○ Length of stay of readmissions↑*
Johnston et al 200619None assessedNone assessedGaps in care
 ○ Missed appointments
Kipps et al 200220SatisfactionDisease-specific measureUtilization
○ Satisfaction with transfera↑* ○ HbA1C ○ Clinic attendance
Lane et al 200721None assessedDisease-specific measureNone assessed
 ○ HbA1C
Logan et al 200822None assessedDisease-specific measureNone assessed
 ○ HbA1C at first versus third visit↑*
 ○ Number of patients with HbA1C <7.5%↑*
Maslow et al 201347None assessedPatient-reported outcome measuresNone assessed
 ○ UCLA Loneliness Scale↑*
Self-care skills
 ○ TRAQ chronic condition management
 ○ TRAQ self-advocacy↑*
Markowitz and Laffel 201223None assessedDisease-specific measure (n = 12)Utilization
 ○ HbA1C ○ Visits to any health care provider (eg, physician, dietician, mental health provider)
Patient-reported outcome measures
 ○ Problem Areas in DM survey↑*
Self-care skills
 ○ Self-Care Inventory-R
McDonagh et al 200731SatisfactionPatient-reported outcome measuresNone assessed
 ○ Satisfaction with rheumatology carea↑* ○ Juvenile Arthritis Quality of Life Questionnaire↑*
Self-care skills
 ○ Arthritis-related knowledgea↑*
 ○ Independent health behaviorsa
Orr et al 199624None assessedDisease-specific measureNone assessed
 ○ HbA1C
Prestidge et al 201229None assessedDisease-specific measureCost
 ○ Serum creatinine ○ Average annual cost per patient (estimated)
Mortality
 ○ Time to graft loss or death
Remorino and Taylor 200630SatisfactionNone assessedNone assessed
 ○ Satisfaction with transfera
Robertson et al 200632None assessedProcess of careUtilization
 ○ Age when independent visit concept introduced↑*○ Joint injections without general anesthesia↑*
 ○ Age when independent visits began↑*
 ○ Age when self-medication discussed↑*
 ○ Age when self-medicating↑*
 ○ Age when making own appointments
 ○ Adolescent readiness↑*
 ○ Structured transition plan↑*
 ○ Patient given:
  ▪ Written information about transition↑*
  ▪ Transfer letter↑*
 ○ Adult provider given:
  ▪ Copy of clinic letters
  ▪ Copy of discharge summaries↑*
  ▪ Medical summary
  ▪ Plan for future management↑*
  ▪ Ophthalmology summary
  ▪ Nursing summary
  ▪ Physiotherapy summary
  ▪ OT summary
  ▪ Dual-energy X-ray absorptiometry scan results
  ▪ CHAQ scores↑*
  ▪ Core outcome variables↑*
  ▪ Growth charts
Self-care skills
 ○ Age when
  ▪ Transfer first discussed
  ▪ Transferred to adult care
  ▪ Independent visit concept introduced↑*
  ▪ Independent visits began
  ▪ Self-medication discussed
  ▪ Self-medicating
  ▪ Making own appointments
 ○ Carrying self-monitoring cards↑*
Shaw et al 200733SatisfactionNone assessedNone assessed
 ○ Satisfaction with rheumatology carea↑*
 ○ Parent satisfaction with rheumatology carea↑*
Smith et al 201136None assessedPatient-reported outcome measuresNone assessed
 ○ Sickle Cell Transfer Questionnaire
Self-care skills
 ○ Sickle Cell Disease Quiz
Van Walleghem et al 200825Barriers to careDisease-specific measureGaps in care
 ○ Difficulties and frustrationa ○ Long-term DM complications ○ Dropping out of adult medical care
Utilization
 ○ Medical visits
 ○ Education visits
 ○ DKA hospital admissions
 ○ Hypoglycemia hospital admissions
Vidal et al 200426None assessedDisease-specific measureUtilization
 ○ HbA1C↑* ○ Total daily insulin dose
 ○ Hypoglycemic episodes↑*
Patient-reported outcome measures
 ○ Diabetes Quality of Life questionnaire
Self-care Skills
 ○ Ability to self-adjust insulin doses↑*
 ○ Diabetes Knowledge Questionnaire 2↑*
Wiener et al 200741None assessedPatient-reported outcome measuresNone assessed
 ○ State/Trait Anxiety Inventory for Adults↑*
Self-care skills
 ○ Transition Readinessa↑*
  • Significance was reported as defined by each article (typically P < .05 or P < .01). TRAQ, Transition Readiness Assessment Questionnaire. HbA1C: hemoglobin A1C. DKA: Diabetic Ketoacidosis. OT: Occupational Therapy. CHAQ: Childhood Health Assessment Questionnaire.

  • ↑* Statistically significant improvement (improved experience, improved population health, decreased cost).

  • ↑ Improvement without statistics given (improved experience, improved population health, decreased cost).

  • ↔ No change or not statistically significant.

  • ↓ Deterioration without statistics given (worsened experience, worsened population health, increased cost).

  • ↓* Statistically significant deterioration (worsened experience, worsened population health, increased cost).

  • a Survey developed by study authors specifically for project.