Background: Transitioning adolescents and young adults (AYA) with bleeding disorders to adult care is a critical process that is often inadequately supported. A baseline review at our lifespan Hemophilia Treatment Center (HTC) showed that only 5% of patients aged 12–26 years had a documented transition readiness assessment between September 2022 and September 2023. Barriers included lack of institutional policy, reliance on a single provider to administer paper forms, variability in form versions, and low staff and patient engagement.

Objective: To increase the percentage of patients aged 12–26 years with bleeding disorders who receive a documented transition readiness assessment from 5% to 70% by December 31, 2024.

Methods:

The project progressed through three Plan-Do-Study-Act (PDSA) cycles. In PDSA 1, a standardized Transition Readiness Assessment Form (TRAF) was developed and transitioned from a paper-based to an electronic format. PDSA 2 focused on embedding the TRAF into the electronic medical record (EMR) with automated assignment to eligible patients, along with targeted staff education to support adoption. In PDSA 3, initiated in February 2025, the TRAF was further integrated into the multidisciplinary sign-in workflow. Monthly education sessions were implemented for check-in and front desk staff, and performance feedback was provided to the care team through monthly reports to enhance awareness and accountability. Process and outcome measures included TRAF completion rates, team adoption of new workflows, and balancing measures such as clinic flow and patient satisfaction.

Results: TRAF completion increased from 5% to over 70% within 15 months of the initial intervention. The run chart revealed a clear upward trend in assessment rates following policy implementation in September 2023, with further increases after EMR integration in January 2024. As of March 2025, completion rates approached 90%. No significant disruption to clinic workflow or patient satisfaction was observed. Success was attributed to EMR automation, real-time performance feedback, and team-wide accountability. Barriers such as missed visits, form fatigue, and role confusion were mitigated through workflow integration and consistent staff education.

Conclusions: A structured, policy-driven approach to transition readiness assessment significantly improved screening rates among AYA with bleeding disorders. Use of root cause analysis and key driver diagrams guided targeted interventions that were effective and sustainable. Future directions include expanding TRAF use to patients up to age 39 and developing personalized educational materials based on TRAF responses for after-visit summaries.

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2025
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