Issue link: https://viewer.e-digitaledition.com/i/862008
diabetes — between the ages of 18 and 25. It essentia lly ra n as a clinica l progra m, tracking factors such as blood glucose mon itor i ng f requency a nd g lycem ic control. W hile most clinica l tra nsition prog ra ms a re ba sed on t he pediatric side of ca re, t h i s model i s ba sed on t he a du lt ca re s yst em a nd i s r u n by endocrinolog ists who treat adults. T h e m o d e l , c a l l e d t h e Pe d i a t r i c to Adu lt Diabetes Tra nsition Cli n ic (PA DTC), utilized a multidisciplina r y t e a m t h a t i nc lude d a du lt d i a b e t e s physicians, nurse practitioners, diabetes nurses, a diabetes educator, a dietitia n a nd a pa r t-time socia l worker. Patients were provided continuing education to improve their self-ma nagement of the d isea se a nd were encou ra ged to set goa ls to keep them engaged with their own ca re. One si g n i f ica nt a dv a nt a ge of t he program is that it utilized only resources a lready available, rather than relying on outside funding. Thus, other facilities ca n more easily replicate the model. "If you look at some of the resources that ma ny of the pediatric tra nsition prog ra ms have had in the pa st , there a re def initely ... funding ba rriers that come up, a nd that may dissuade people from attempting something like this," says Serena Ca rdi l lo, MD, A ssociate P r o f e s s o r o f C l i n i c a l M e d i c i n e a nd D i re c t or of Gr a du at e D i a b et e s Education at the Rodebaugh Diabetes Center. "[We] just utilized our a mazing st a f f of educators a nd nut r it ion ist s a nd were able to rea lly demonstrate a sig nif ica nt improvement." PROMISING OUTCOMES Dr. Agarwal and Dr. Cardillo's fi ndings come from only a six-month period and a re a prelimina r y look at something t h e r e s e a r c h t e a m w a n t s t o d i v e into more deeply. A mong their most signifi cant fi ndings: + Mean A1C decreased by 0.7 percent from baseline, with improvement in some patients ranging up to almost 2 percent. + Frequency of blood glucose monitoring increased by one check per day. " If we can move the needle on this hemoglobin A1C value [with this model], we really have done something remarkable." — SHIVANI AGARWAL, MD, MPH, DIRECTOR OF THE DIABETES TRANSITION CLINIC AT THE RODEBAUGH DIABETES CENTER AT THE UNIVERSITY OF PENNSYLVANIA + A lmost 90 percent of pa r ticipa nts at tended t wo or more hea lt hca re provider visits during the study. Regarding the fi rst metric, Dr. Agarwal says, "It 's rea lly important to show an i mprovement i n t h is ha rd outcome, becau se a l l of t he l a r ge popu l at ion studies show that the hemoglobin A1C level is linked with long-term diabetes- related complications and morta lity." OTHER RESEARCH T h e r e a p p e a r s t o b e s i g n i f i c a n t r e c o g n i t i o n o f t h e c h a l l e n g e s o f transitioning pediatric patients to adult ca re. R ecent ly, resea rchers at Rush University in Colorado a lso developed a new model for that process. The approach Jea nne Lit t le, DN P, CPNP-AC/PC, facult y with the Rush University College of Nursing, and fellow resea rchers took wa s to create a tool within their EHR that automatica lly sor ts their ta rget patient population: those age 14 or older with a diag nosis of diabetes on their problem list. They discussed their eff orts earlier this year in the Journal of Pediatric Health Care, though full results are not yet available. " The reg istr y conta ins key hea lt h information of this targeted population, s o it w a s a n e a s y w a y t o s e e h o w ma ny patients we have who should be transitioning and we should be planning with," Little says. "It gives us specifi cs on their age a nd date of bir th. It a lso provides their most recent hemoglobin A 1C so we ca n see quick ly how their glycemic control is." Little and her colleagues a lso utilized the Transition Readiness Assessment Q ues t ion n a i re ( T R AQ ), wh ich wa s a d m i n i s t e r e d t o p a t i e nt s i n t h e i r ta rget population at each clinic visit. It mea sures fi ve doma ins: ma na g ing medications, keeping appointments, track ing hea lt h issues, ta l k ing w it h providers and managing daily activities. Tracking a patient 's responses a llowed the team to know what areas required the most attention, where goals should be set and where the patient was improving visit to visit. MOVING FORWARD L o o k i n g a h e a d , D r. A g a r w a l a n d Dr. Ca rdi l lo hope to dig deeper i nto s o c i o e c o n o m i c f a c t o r s a f f e c t i n g access to ca re. Their prog ra m ser ves both patients with strong familia l and fi nancia l support, as well as those who lack those advantages. " W hile this is a ver y sma ll and early s t udy, we a re s t a r t i n g t o t ea se out some of those diff erences, a nd I think that under-resourced population is at particularly high risk for poor control a nd ch a l len ge s i n t h i s t r a n sit ion ," Dr. Ca rdi l lo says. " Identif y ing what aspects of this progra m work well for this population, what the defi ciencies are in terms of what we're off ering, and how we fi ll those gaps and needs for that pa r ticula r population ... is going to be the next step." n SPECIAL CLINICAL SECTION: PEDIATRICS 1 7 M D N E W S .C O M /// M D N E W S M I D H U D S O N ■ 2 017