Care Coordination and Comprehensive Electronic Health Records are Associated with Increased Transition Planning Activities

Abstract

OBJECTIVE: Youth with Special Health Care Needs (YSHCN) require assistance from their pediatricians to transition to adult care. There is little data on what transition resources pediatricians have. This paper studies if care coordination and/or comprehensive electronic health record (CEHR) implementation are associated with improved transition processes. METHODS: Using AAP Periodic Survey #79, we report whether practices generated written transition plans, assisted in finding adult providers, and discussed confidentiality issues. Descriptive statistics and a logistic regression model were done to evaluate whether CEHR, care coordination, or practice and physician characteristics improve transition planning. RESULTS: Transition planning support in practices is low. Pediatricians with any care coordinator report more written transition plans for YSHCN (23% vs. 6%, p<0.001), assistance identifying adult providers (59% vs. 39%, p<0.001), and discussing confidentiality issues (50% vs. 33%, p<0.001). Pediatricians with a CEHR compared to those without are more likely to report written transition plans for YSHCN (24% vs. 12 % p<0.05) and discussing confidentiality issues (51% vs. 39%, p<0.05). In the logistic regression model, having care coordination (AOR 11.1, 95% CI 5.9-21.3) and CEHR (AOR 2.6, 95% CI 1.5-5.0) are independently associated with higher odds of having a written transition plan. CONCLUSIONS: Only 1 in 5 pediatricians have a transition coordinator in their practice and just 15% have a CEHR, even as these resources are associated with improved transition processes for YSHCN. Policy decisions should be made to help practices with supports, such as care coordination and EHR implementation, in order to improve transitions to adulthood.