57 Transition from paediatric to adult care: Current practices and barriers to care
Bibliographic record
Abstract
Abstract Background Transition from paediatric to adult care is a challenging process. A recent Canadian Paediatric Society (CPS) call for action highlights difficulties in transition of care and calls on healthcare providers to advocate for improved transition practices. Results of this project will provide a guideline to develop transition standards in children’s hospitals across Canada. Objectives To assess transition from paediatric to adult care resources at a tertiary paediatric institution and compare current resources to transition standards across paediatric disciplines. Design/Methods A multidisciplinary survey was completed in a tertiary paediatric institution in Southwestern Ontario. An extensive literature review of 182 articles guided survey development, with a focus on transition of care standards, identifying common themes and complementing the CPS core components of successful transition. Mixed methods analysis was completed. Results There were 66 responses, 27% paediatric subspecialists, 64% allied health, and 9% other. Many providers noted significant barriers to transition care: 91% were not satisfied with the current way patients are transitioned from paediatric to adult care, 85% noted insufficient resources and personnel to adequately address transition care, 61% felt uncomfortable addressing transition patient general health needs, and 73% were in need of additional tools to facilitate transition. The top three barriers to adequate transition were lack of communication and guidelines between paediatric and adult systems, lack of allied health providers to support transition, and lack of adult specialists to provide transition care. Regarding transition standards of care, almost half of providers were following an informal transition policy. 72% had no designated transition clinic and 68% had no multidisciplinary transition team. 88% had no formal training in transition and almost half of providers noted no quality improvement or research initiatives in transition. Regarding recommended transition practices, the least performed practices were formally assessing transition readiness using a standardized tool, completing part of transition encounters with caregivers outside of the room, and discussing psychosocial factors related to transition. Regarding transition resources, 16% of providers had accessed the CPS statement on transition from paediatric to adult care. Conclusion Most providers were unsatisfied with transition practices and noted barriers relating to collaboration with adult specialists and lack of resources to support transition. Transition standards of care were poorly adhered to, with majority of participants noting no transition policy or team, no assessment of transition readiness, and poor use of transition resources. These results will inform hospital-wide and eventually nation-wide transition from paediatric to adult care guidelines.
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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 | 0.008 | 0.028 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".