Transition from child focused to adult focused care | Overview
The Adolescent Assessment of Preparation for Transition (ADAPT) survey is an adolescent patient experience survey developed to measure the quality of pre-transition counseling from adolescent-focused to adult-focused care for 16- and 17-year-old adolescents with chronic conditions. Funded through the Pediatric Quality Measures Program (PQMP) by the federal Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS), the Center of Excellence for Pediatric Quality Measurement (CEPQM) developed this patient-reported survey measure to be made available to public and private payers, providers, and consumers. The final 26-item survey instrument has 3 composite measures: counseling on transition self-management, counseling on prescription medication, and transfer planning. The measures are case-mix adjusted. It may be used to assess quality at the health plan, delivery system, or practice level. The ADAPT survey fills a significant gap in pediatric quality measurement by serving as a validated tool to assess the quality of transition preparation in adolescents with chronic health conditions. The survey is endorsed by the National Quality Forum (NQF).
The term “health care transition” broadly encompasses the developmental time period spanning from early adolescence to emerging adulthood (roughly ages 12-26 years). Milestones along this period for youth with chronic medical conditions include the development of transition readiness, engagement in chronic disease self-management, and preparation of adult caregivers for eventual transfer of care. Finally, HCT culminates in the establishment of care in the adult-oriented health system. In 2002, a consensus statement on HCT envisioned the goal that by 2010 all physicians who provide primary or subspecialty care to youth with special health care needs (YSHCN) “1) understand the rationale for transition from child-oriented to adult-oriented health care; 2) have the knowledge and skills to facilitate that process; and 3) know if, how, and when transfer of care is indicated.”
However, analysis of the 2007 Survey of Adult Transition and Health (SATH) found that just over one-half of youth ages 19-23 years reported receiving counseling around HCT. These data suggest that many youths, regardless of disease severity, are not receiving anticipatory guidance to support transition to adult care from their pediatric health care providers.
ADAPT Core Team
- Mark Schuster, MD, PhD (Kaiser Permanente, Boston Children’s Hospital, and Harvard Medical School)
- Jonathan Finkelstein, MD, MPH (Boston Children’s Hospital and Harvard Medical School)
- Katharine Garvey, MD, MPH (Boston Children’s Hospital and Harvard Medical School)
- Gregory Sawicki, MD, MPH (Boston Children’s Hospital and Harvard Medical School)
- Sara Toomey, MD, MPH, MPhil, MSc (Boston Children’s Hospital and Harvard Medical School)