Transition of Children with Medical Complexity To Adult Care: A Survey of Current Canadian Practices
Bibliographic record
Abstract
Abstract BACKGROUND: Children with medical complexity (CMC), among the most medically fragile and resource-intensive patients, are an ever-growing population. Unique barriers exist for successful transition of CMC to adult care. Transition care specific to CMC has not been previously studied. OBJECTIVES: To describe transition policy and procedures used by Canadian pediatricians who care for CMC, and whether this is consistent with core elements of transition according to nationalguidelines. To identify pediatricians'; perceived barriers to successful transition of CMC. DESIGN/METHODS: We conducted a 29-item online survey using REDCap of Canadian general pediatricians who provide transition care to CMC. Use of core elements of transition as per Canadian Paediatric Society (CPS) and American Academy of Pediatrics (AAP) statements, and perceived barriers to transition were measured using 5-point Likert scales. Descriptive analysis was performed using SAS 9.3. RESULTS: The response rate was 30% (77/). 19% of pediatricians reported feeling satisfied with their success in transitioning CMC to adult care. 51% and 40% have read the CPS and AAP policy statements on transition, respectively. 22% have a specified set of procedures on transition for CMC at their institution. 23% performed assessments for transition readiness. In transition planning for capable CMC, 69% assessed knowledge of own medical condition and 54% assessed preparedness to navigate adult services independently. For CMC with neurocognitive disabilities, 65% discussed capacity and 53% reviewed care directives. 2% felt the legal process regarding capacity was easy to navigate for families, and 52% provided no legal resources to families during transition. 59% did not have existing relationships with adult practitioners willing to take on care coordination of CMC. 86% communicated with receiving adult practitioners upon transfer of care. Pediatricians' major perceived barriers to successful transition are listed in Table 1. CONCLUSION: Only 1 in 5 Canadian pediatricians working with CMC reported satisfaction with the transition care they provide. Core elements of transition from national guidelines are inconsistently implemented, highlighting the need to develop evidence-based transition policy considering the unique needs and barriers experienced by CMC.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".