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Quality Improvement Targeting Adherence During the Transition from a Pediatric to Adult Liver Transplant Clinic

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Abstract

The transition from pediatric to adult transplant care is a high risk period for non-adherence and poor health outcomes. This article describes a quality improvement initiative integrated into a pediatric liver transplant program that focused on improving outcomes following the transfer from pediatric to adult liver transplant care. Using improvement science methodology, we evaluated the impact of our center’s transition readiness skills (TRS) program by conducting a chart review of 45 pediatric liver transplant recipients who transferred to adult transplant care. Medication adherence, clinic attendance, and health status variables were examined for the year pre-transfer and first year post-transfer. 19 recipients transferred without participating in the TRS program (control group) and 26 recipients participated in the program prior to transferring to the adult clinic (TRS group). The TRS group was significantly older at the time of transfer, more adherent with medications, and more likely to attend their first adult clinic visit compared to the control group. Among the TRS group, better adolescent and parent regimen knowledge were associated with greater adherence to post-transfer clinic appointments. Transition planning should focus on the gradual shift in responsibility for health management tasks, including clinic attendance, from parent to adolescent. There may be support for extending transition support for at least 1 year post-transfer to promote adherence.

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Acknowledgments

This work was supported in part by a K23 award from the National Institutes of Health (Grant Number DK090202) to EMF.

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Authors and Affiliations

  1. University of Michigan Medical School and C.S. Mott Children’s Hospital, Ann Arbor, MI, 48109, USA

    Emily M. Fredericks, John C. Magee, Sally J. Eder, Jessica R. Sevecke, Dawn Dore-Stites, Victoria Shieck & M. James Lopez

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  1. Emily M. Fredericks
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  2. John C. Magee
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  3. Sally J. Eder
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  4. Jessica R. Sevecke
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  5. Dawn Dore-Stites
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  6. Victoria Shieck
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  7. M. James Lopez
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Correspondence to Emily M. Fredericks.

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Conflict of interest

Emily M. Fredericks, John C. Magee, Sally J. Eder, Jessica R. Sevecke, Dawn Dore-Stites, Victoria Shieck, and M. James Lopez declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. Informed consent was waived as our Institutional Review Board determined that this quality improvement program was exempt from review.

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Fredericks, E.M., Magee, J.C., Eder, S.J. et al. Quality Improvement Targeting Adherence During the Transition from a Pediatric to Adult Liver Transplant Clinic. J Clin Psychol Med Settings 22, 150–159 (2015). https://doi.org/10.1007/s10880-015-9427-6

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