Implementing a Structured Health Care Transition (HCT) Process for Sickle Cell Disease (SCD) Using Quality Improvement (QI): Early Results of a SCD HCT Learning Collaorative

Background: A regional SCD HCT learning collaborative (SCD-LC) was formed from engaging 14 pediatric and adult paired sites (including required community participation) using a standardized HCT quality improvement process. The SCD-LC involved a kick-off meeting and monthly calls to establish a common understanding of clinical recommendations, QI methods, and implementation of the Six Core Elements of HCT (6CE).

Methods: Implementation of 6CE was measured as part of a SCD HCT Study conducted in 14 paired SCD clinical sites with pediatric, adult and community partners who care for 1625 individuals aged 16-25. They represent a variety of clinical programs:12 urban and 2 rural, 12 academic and 2 nonacademic, 6 small and 8 large. Got Transition's Process Measurement Tool (HCTPMT) was customized for SCD and used to assess 6CE implementation. HCTPMT were completed by 14 pediatric and 14 adult sites at baseline (2018) and after 6 months. Pre-post results were compared overall and by type of practice.

Results: All 14 participating sites made substantial progress towards implementing a structured HCT process consistent with the within the first 6 months of the project. Overall, baseline scores averaged 19.4 (SD 14.1) and after 6 months of QI support, scores increased to 33.7 (SD 19.4) (average change 14.3, p<0.0001). For the 14 pediatric sites, scores went from 24 to 43 (p 0.0016), and for the 14 adult sites, from 15 to 24 (p 0.0017). Pediatric sites had higher scores at 6 months compared to adult sites (p=0.0068). Although their change over time was higher, it did not reach statistical significance at 0.05 (p=0.0759). Large sites went from 21 to 34 (delta 14, p=0.0048), small went from 18 to 32 (delta 15, p=0.0018).

Conclusion: All 14 pediatric and adult sites reported significant progress within 6 months of implementing a structured HCT process aligned with the 6CE.